Views on sick-listing practice among Swedish General Practitioners – a phenomenographic study

Abstract

Background: The number of people on sick-leave started to increase in Sweden and several other European countries towards the end of the 20 th century. Physicians play an important role in the sickness insurance system by acting as gate-keepers. Our aim was to explore how General Practitioners (GPs) view their sick-listing commission and sick-listing practice.

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

“…We found that some physicians deliberately issued vague certificates, knowing that the sick leave would not be approved by the SIO. This indicates that making assessments in the role as medical expert for the social insurance office is difficult to maintain, which supports previous findings [9,14]. The lack of trust and confidence in each other affecting the collaboration between the SIO and the healthcare system has been described as a conflict explained by different perspectives on disease and work ability; reductionist versus holistic [44,26].…”

“…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].…”

Description of functioning in sickness certificates

“…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.…”

Does variation in general practitioner (GP) practice matter for the length of sick leave? A multilevel analysis based on Norwegian GP-patient data

“…GPs act as gatekeepers in the sickness benefit system in most western European countries, see for instance, Stone (1979), Meershoek et al (2007), Swartling et al (2007). GP responsibilities include assessing ability to work and issuing certificates for sick leave based on an evaluation of the patient.…”