GPs’ negotiation strategies regarding sick leave for subjective health complaints

Nilsen, Stein; Malterud, Kirsti; Werner, Erik L.; Mæland, Silje; Magnussen, Liv Heide

doi:10.3109/02813432.2015.1001943

Cited by 28 publications

(22 citation statements)

References 29 publications

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“…This is in accordance with previous findings. [ 40 ] A lack of an objective measure of nausea to enable documentation for NAV on the grounds on which the sick leave is being prescribed was mentioned in relation to the sick leave dilemma. The Pregnancy-Unique Quantification of Emesis (PUQE) scale has been translated into Norwegian and is included in the new national guideline for treatment of NVP.…”

Section: Discussionmentioning

confidence: 99%

Nausea in pregnancy: attitudes among pregnant women and general practitioners on treatment and pregnancy care

Heitmann

Svendsen

Sporsheim

et al. 2016

Scandinavian Journal of Primary Health Care

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ObjectiveNausea and vomiting during pregnancy (NVP) is very common, and may have great impact on a woman’s life. The aim of this study was to explore thoughts and attitudes among Norwegian pregnant women and GPs on treatment of NVP and pregnancy care.DesignFocus-group study.Setting and subjectsSeparate focus-group discussions were conducted with pregnant women and GPs.ResultsTwo focus-group discussions were conducted with pregnant women and two with GPs. The GPs thought it was important to normalize NVP symptoms. However, the women felt their distress due to NVP was trivialized by the GPs. The women were sceptical towards the use of medicines while pregnant, and avoidance was sought despite being ill. The GPs appeared uncertain with respect to medical treatment of NVP, which was stated to be considered only after progression to quite severe symptoms. Sick leave seemed to be an important part of the treatment regime applied by the GPs. The women had good experiences with graded sick leave.ConclusionThis Norwegian study identifies attitudes among GPs and pregnant women that may act as obstacles to appropriate care for women with NVP. The pregnant women and the GPs seemed to talk at cross-purposes; GPs’ normalization of the symptoms made the women feel that their distress due to NVP was trivialized by the GPs. Our results indicate that pregnant women with NVP requiring medical treatment probably need comprehensive and reassuring information about treatment options before considering using any medicines. Key pointsNausea and vomiting during pregnancy (NVP) is very common, and considered to be of clinical significance for 35% of women. While the GPs agreed on the importance of normalizing the symptoms, the women felt their distress was trivialized, and missed being properly evaluated.Both the GPs and the women showed a reluctant attitude to medical treatment of NVP.The GPs gave the impression of considering medical treatment only after progression of symptoms to becoming quite severe.

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Section: Discussionmentioning

confidence: 99%

Nausea in pregnancy: attitudes among pregnant women and general practitioners on treatment and pregnancy care

Heitmann

Svendsen

Sporsheim

et al. 2016

Scandinavian Journal of Primary Health Care

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“…Other questions also arise with respect to the strategies that should be implemented simultaneously to preserve a working alliance with the patient. Studies such as those by Money et al [ 31 ] and Nilsen et al [ 32 ] have provided good descriptions of the potential for conflict during the negotiation of sick leave and RTW. It is likely that a proactive approach towards work, as described by profile 1, may generate such conflicts.…”

Section: Discussionmentioning

confidence: 99%

How do general practitioners contribute to preventing long-term work disability of their patients suffering from depressive disorders? A qualitative study

et al. 2016

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BackgroundDepression is a major cause of work absenteeism that general practitioners (GPs) face directly since they are responsible for sickness certification and for supervising the return to work (RTW). These activities give GPs a key role in preventing long-term work disability, yet their practices in this regard remain poorly documented. The objectives of this study were therefore to describe GPs’ practices with people experiencing work disability due to depressive disorders and explore how GPs’ work context may impact on their practices.MethodsWe conducted semi-structured individual interviews with 13 GPs and six mental healthcare professionals in two sub-regions of Quebec. The sub-regions differed in terms of availability of specialized resources offering public mental health services. Data were anonymized and transcribed verbatim. Thematic analysis was performed to identify patterns in the GPs’ practices and highlight impacting factors in their work context.ResultsOur results identified a set of practices common to all the GPs and other practices that differentiated them. Two profiles were defined on the basis of the various practices documented. The first is characterized by the integration of the RTW goal into the treatment goal right from sickness certification and by interventions that include the workplace, albeit indirectly. The second is characterized by a lack of early RTW-oriented action and by interventions that include little workplace involvement. Regardless of the practice profile, actions intended to improve collaboration with key stakeholders remain the exception. However, two characteristics of the work context appear to have an impact: the availability of a dedicated mental health nurse and the regular provision of clinical information by psychotherapists. These conditions are rarely present but tend to make a significant difference for the GPs.ConclusionsOur results highlight the significant role of GPs in the prevention of long-term work disability and their need for support through the organization of mental health services at the primary care level.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0459-2) contains supplementary material, which is available to authorized users.

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“…In the medical profession, however, this role conflict is widely acknowledged (Alexanderson et al, 2009;Angell, 1993;Arnesen & Fredriksen, 1995;Ayres, 1996;Carlsen & Norheim, 2005;Pearson, 2000). Several empirical studies have found that primary care physicians are indeed reluctant to reject patients' requests for sickness certificates (Carlsen & Norheim, 2003;Englund, Tibblin, & Svärdsudd, 2000;Gulbrandsen, Førde, & Aasland, 2002;Larsen, Førde, & Tellnes, 1994;Nilsen, Malterud, Werner, Maeland, & Magnussen, 2015;Wahlström & Alexanderson, 2004).…”

Section: Introductionmentioning

confidence: 99%

Why physicians are lousy gatekeepers: Sicklisting decisions when patients have private information on symptoms

2020

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In social insurance systems that grant workers paid sick leave, physicians act as gatekeepers, supposedly granting sickness certificates to the sick and not to shirkers. Previous research has emphasized the physician's superior ability to judge patients' need of treatment and potential collusion with the patient vis-ávis an insurer. What is less well understood is the role of patients' private information. We explore the case where patients have private information about the presence of nonverifiable symptoms. Anyone can then claim to experience such symptoms, reducing physicians' ability to distinguish between sick patients and shirkers. Doubting a patients' reported symptoms may prevent good medical treatment of the truly sick. We show that for all parameter values, the Bayesian Nash equilibrium is that some physicians trust all claims of nonverifiable symptoms, sicklisting shirkers as well as sick; for many values, every physician is trusting. In particular, if physician strategies are observable by patients, extremely strong gatekeeping preferences are required to make physicians mistrust. To limit unwarranted sicklisting, policies reducing the benefits of shirking for healthy workers may be better suited than attempts to convince physicians to be strict. K E Y W O R D S moral hazard, physician gatekeeper, sick leave J E L C L A S S I F I C A T I O N D11; D21; H42; I11; I18

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GPs’ negotiation strategies regarding sick leave for subjective health complaints

Cited by 28 publications

References 29 publications

Nausea in pregnancy: attitudes among pregnant women and general practitioners on treatment and pregnancy care

Nausea in pregnancy: attitudes among pregnant women and general practitioners on treatment and pregnancy care

How do general practitioners contribute to preventing long-term work disability of their patients suffering from depressive disorders? A qualitative study

Why physicians are lousy gatekeepers: Sicklisting decisions when patients have private information on symptoms

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