Isolated specialist or system integrated physician – different views on sickness certification among orthopaedic surgeons: an interview study

Swartling, Malin; Wahlström, Rolf

doi:10.1186/1472-6963-8-273

Cited by 12 publications

(10 citation statements)

References 21 publications

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“…This finding was confirmed in a logistic regression analysis on the description of functioning according to the activity component. Our results and findings from earlier research on physicians' sicknesscertification practice regarding quality in certificates [12], certification of sick leave [16] and experiences of certification as problematic [3,[7][8][9]25], imply that there may be a need for interventions to reduce these variations and to increase the quality in sickness certificates. The results from a survey by Löfgren et al [26] including physicians with different specialities suggested that the low quality in sickness certificates may not be explained by the need for more knowledge or skills in filling out sickness certificates.…”

Section: According To Icf Functioning Is Conceptualised As Consequensupporting

confidence: 52%

Description of functioning in sickness certificates

Nilsing

Söderberg

Normelli

et al. 2011

Scand J Public Health

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Aims. Sickness certificates are to provide information on a disease and its consequences on the patient's functioning. This information has implications for the patient's rights to sickness benefits and return to work measures. The objective of this study was to investigate the description of functioning in sickness certificates according to WHO's International Classification of Functioning, Disability, and Health (ICF), and to describe the influence of patients' age, gender, diagnostic group, and affiliation of certifying physician. Method. A content analysis of written statements regarding how the disease limits the patient's

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Section: According To Icf Functioning Is Conceptualised As Consequensupporting

confidence: 52%

Description of functioning in sickness certificates

Nilsing

Söderberg

Normelli

et al. 2011

Scand J Public Health

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“…Although a central part of the sickness absence and rehabilitation process, physicians' work with assessing work capacity has received little attention. Previous studies have examined physicians' sickness certification practices both quantitatively and qualitatively regarding frequency [18], experiences and feelings [38][39][40], perceived problems [41,42] and strategies [43] but their actual clinical practice when determining work capacity has received little attention. This is, to our knowledge, the first synthesis of qualitative research on the matter.…”

Section: Discussionmentioning

confidence: 99%

Assessing work capacity – reviewing the what and how of physicians’ clinical practice

et al. 2020

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Background: Although a main task in the sickness certification process, physicians' clinical practice when assessing work capacity has not been thoroughly described. Increased knowledge on the matter is needed to better understand and support the certification process. In this review, we aimed to synthesise existing qualitative evidence to provide a clearer description of the assessment of work capacity as practiced by physicians. Method: Seven electronic databases were searched systematically for qualitative studies examining what and how physicians do when they assess work capacity. Data was analysed and integrated using thematic synthesis. Results: Twelve articles were included. Results show that physicians seek to form a knowledge base including understanding the condition, the patient and the patient's workplace. They consider both medical and non-medical aspects to affect work capacity. To acquire and process the information they use various skills, methods and resources. Medical competence is an important basis, but not enough. Time, trust, intuition and reasoning are also used to assess the patient's claims and to translate the findings into a final assessment. The depth and focus of the information seeking and processing vary depending on several factors. Conclusion: The assessment of work capacity is a complex task where physicians rely on their non-medical skills to a higher degree than in ordinary clinical work. These skills are highly relevant but need to be complemented with access to appropriate resources such as understanding of the associations between health, work and social security, enough time in daily work for the assessment and ways to better understand the patient's work place. Also, the notion of an "objective" evaluation is questioned, calling for a greater appreciation of the complexity of the assessment and the role of professional judgement.

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“…Psychiatry is a discipline where any sickness certification consultation could be a challenge, irrespective of the duration, based on difficulties establishing diagnosis and how the symptoms or disease affect the patient’s work capacity [ 48 , 49 ]. In an interview study among orthopaedists, some informants did not perceive sickness certification to be part of their job [ 50 ]. That opinion could possibly have contributed to the somewhat high ORs for finding it problematic to handle sickness certifications of most durations among orthopaedists in our study.…”

Section: Discussionmentioning

confidence: 99%

Problems with sickness certification tasks: experiences from physicians in different clinical settings. A cross-sectional nationwide study in Sweden

Ljungquist

Hinas

Nilsson

et al. 2015

BMC Health Serv Res

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BackgroundMany physicians find sickness certification of patients problematic. The aims were to explore problems that physicians in different clinical settings experience with sickness certification tasks in general and with assessment of function, work capacity, and need for sick leave, as well as handling of sick-leave spells of different durations.MethodsData from a questionnaire sent to 33 144 physicians aged <68 years, living and working in Sweden in 2012 were analysed. The response rate was 57.6 %. The study group comprised the 12 933 responders who had sickness certification tasks. Frequencies and odds ratios with 95 % confidence intervals were calculated for questions concerning how problematic the physicians experienced different assessments related to patients’ function, work capacity, and need for sick leave, as well as handling sick-leave spells of different durations.ResultsThere were large differences between clinical settings regarding how often and to what extent sickness certification consultations were perceived as problematic. Physicians working in primary health care (PHC) had the highest proportions experiencing sickness certification consultations as problematic at least once a week (49.5 %) and as very or fairly problematic (56.6 %), followed by physicians working in psychiatry, pain management, or orthopaedics. More than half of the responders found it very or fairly problematic to assess patients’ work capacity (57.8 %), to make a long-term prognosis about patients’ future work capacity (55.7 %), and to handle long-term or very long-term sickness certifications (51.9 % and 51.8 %). The proportions were highest among physicians working in PHC, rheumatology, neurology, or psychiatry.ConclusionsThe rates of physicians finding sickness certification task problematic varied much with clinical setting, and were highest among physicians in PHC. More knowledge is needed about the work conditions and prerequisites for optimal handling of sickness certification in different clinical settings.

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Isolated specialist or system integrated physician – different views on sickness certification among orthopaedic surgeons: an interview study

Abstract: Background: Sickness certification is a frequent and sometimes problematic task for orthopaedic surgeons.

Cited by 12 publications

References 21 publications

Description of functioning in sickness certificates

Description of functioning in sickness certificates

Assessing work capacity – reviewing the what and how of physicians’ clinical practice

Problems with sickness certification tasks: experiences from physicians in different clinical settings. A cross-sectional nationwide study in Sweden

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