Physicians' assessments of work capacity in patients with severe subjective health complaints: a cross-sectional study on differences between five European countries

Abstract

ObjectivesA comparison of appraisals made by general practitioners (GPs) in France and occupational physicians (OPs) and insurance physicians (IPs) in the Netherlands with those made by Scandinavian GPs on work capacity in patients with severe subjective health complaints (SHCs).SettingGPs in France and OPs/IPs in the Netherlands gathered to watch nine authentic video recordings from a Norwegian general practice.Participants46 GPs in France and 93 OPs/IPs in the Netherlands were invited to a 1-day course on SHC.OutcomesRecommendation of sick leave (full or partial) or no sick leave for each of the patients.ResultsCompared with Norwegian GPs, sick leave was less likely to be granted by Swedish GPs (OR 0.51, 95% CI 0.30 to 0.86) and by Dutch OPs/IPs (OR 0.53, 95% CI 0.37 to 0.78). The differences between Swedish and Norwegian GPs were maintained in the adjusted analyses (OR 0.43, 95% CI 0.23 to 0.79). This was also true for the differences between Dutch and Norwegian physicians (OR 0.55, 95% CI 0.36 to 0.86). Overall, compared with the GPs, the Dutch OPs/IPs were less likely to grant sick leave (OR 0.60, 95% CI 0.45 to 0.87).ConclusionsSwedish GPs and Dutch OPs/IPs were less likely to grant sick leave to patients with severe SHC compared with GPs from Norway, while GPs from Denmark and France were just as likely to grant sick leave as the Norwegian GPs. We suggest that these findings may be due to the guidelines on sick-listing and on patients with severe SHC which exist in Sweden and the Netherlands, respectively. Differences in the working conditions, relationships with patients and training of specialists in occupational medicine may also have affected the results. However, a pattern was observed in which of the patients the physicians in all countries thought should be sick-listed, suggesting that the physicians share tacit knowledge regarding sick leave decision-making in patients with severe SHC.

Predicting return to work among patients with colorectal cancer

“…In the Netherlands, the employer is obliged to pay the salary of the sick employee for 2 years after the start of sick leave. The rate of return to work of 67·5 per cent at 2 years after the start of the sick leave in the present study is comparable to results in other countries (60–83 per cent).…”

Physicians’ Mental Health and Nationality Affect how Work Characteristics Influence Presenteeism

“…A plausible explanation for this rather paradoxical finding can be related to the question used to measure presenteeism. By asking physicians who had gone to work with an illness if they would have recommended that a patient stay home, the question used to measure presenteeism may have confounded national differences with sick-listing practices (Werner et al, 2016). Although limited to patients with severe subjective health complaints, the study by Werner et al (2016) demonstrated that Norwegian physicians grant sick leave to patients more often than do Swedish physicians.…”

“…By asking physicians who had gone to work with an illness if they would have recommended that a patient stay home, the question used to measure presenteeism may have confounded national differences with sick-listing practices (Werner et al, 2016). Although limited to patients with severe subjective health complaints, the study by Werner et al (2016) demonstrated that Norwegian physicians grant sick leave to patients more often than do Swedish physicians. By illustrating how structures in the broader social environment can influence studies on presenteeism, this highlights the relevance of differentiating estimates by respondents' nationality.…”

“…The question used to measure presenteeism was chosen due to physicians' unwillingness to adopt the patient role (McKevitt et al, 1997). On the one hand, as Norwegian physicians have been shown to recommend sick leave to patients more often than Swedish physicians (Werner et al, 2016), the question measuring presenteeism may have confounded with national differences in sick-listing practices. On the other hand, however, as physicians have limited experience with their own sick leave, the question forced the physicians to relate to a common context by having them consider themselves as patients.…”

Sick leave assessments of workers with subjective health complaints: a cross-sectional study on differences among physicians working in occupational health care

“…These differences may be even more noticeable among physicians with different medical expertise or working in different settings with different frames of reference (such as national policies), or with different tasks and roles. A previous study reported that physicians from different European countries indeed differ in the outcome on sick leave assessments of workers with subjective health complaints [21]. This study compared the outcome of sick leave assessments of GPs from Sweden, Norway, Denmark and France, with insurance physicians and occupational physicians in the Netherlands [21].…”