Sick-listing as a Psychosocial Work Problem: A Survey of 3997 Swedish Physicians

Abstract

The extent and nature of sick-listing problems warrant further concerns, especially in PHCCs. The nature of perceived threats should be elucidated. Developing workplace policies on sick-listing should be encouraged.

Primary Healthcare Professionals’ Experiences of the Sick Leave Process: A Focus Group Study in Sweden

“…There may also be an internal conflict in the advocacy role, as shown in the difficulties deciding whether to meet a patient's request for a sickness certificate or not, primarily when clinical findings are missing. Our findings suggest that the challenges with handling the need for sick leave in PHC are not only faced by physicians, as previously reported [38,9,8,4,11], but also by other professionals. These professionals' described challenges in defending the physician's decision to not issue a sickness certificate, convincing the patient to stay at work, or arguing with the physician about the patient's need for sick leave.…”

“…In our study, the conflict in role responsibility between the patient advocacy and medical expert for the social security system was found to be valid for different professionals, who primarily considered them to represent the patient. This role conflict has been reported by physicians [9,11,8] and recently also by physiotherapists [24].…”

“…There is limited scientific evidence from studies conducted in several countries showing that physicians, especially those in primary healthcare (PHC) practice, consider sickness certification problematic [5-9, 4, 10], or even as a work environment problem [11,12]. One of the problems related to sickness certification is the difficulty in handling the dual roles of patient advocate and medical expert for other authorities like social security, where the responsibility to the patient often outweighs that of medical expert [9,8,13,4,11,14].…”

“…One of the problems related to sickness certification is the difficulty in handling the dual roles of patient advocate and medical expert for other authorities like social security, where the responsibility to the patient often outweighs that of medical expert [9,8,13,4,11,14]. Physicians have reported assessments of functioning, work ability, and the need for sick leave as being problematic [6,15,4], especially when the patient describes symptoms that are difficult to diagnose and clinical findings are missing [9,5,13,16].…”

Barriers to good sickness certification — an interview study with Swedish general practitioners

“…Over 60% of general practitioners (GPs) report having such consultations six or more times per week [1]. Physicians, especially GPs, have been shown to experience sick-listing as problematic [1][2][3][4][5][6][7][8][9]. Physicians' sick-listing practices are one determinant of the level of sickness absence in society [4].…”