Work ability – experiences and perceptions among physicians

Abstract

We found that physicians mainly rely on what patients were telling about their work situation when assessing work ability. But it was not clear if they should consider the patient's whole life situation, motivation and wishes. Protecting the physician-patient relationship was seen as important as well as the need for teamwork assessments and increased work place knowledge.

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

“…Our results support previous findings regarding the problems of assessing work ability, especially when clinical findings are missing [9,13,16,5], but also reveal that the presence of psychological, social, or work-related factors aggravate the assessments. The finding that physicians primarily base their assessments on a feeling of trust in the information given by the patient agrees with earlier research [16,21,18]. In line with a previous study [16], we found that the patient's ability to evoke empathy and describe his or her symptoms and working conditions played an important role in obtaining the sickness certification.…”

“…The work ability assessment is central for entitlement of sickness benefits in the Swedish social security system, but our findings indicate that the work ability assessment may not be that central in practice. This finding is supported by an interview study with physicians, who did not perceive work ability assessments as a main assignment, but rather something they were forced to handle [18]. Whether sickness certifications would improve with the involvement of other healthcare professionals in work ability assessments needs to be further investigated.…”

“…The challenges physicians face in sickness certifications may come from insufficient competence to assess work ability [10,7,20] as well as scarce knowledge about workplaces, the labour market, and the social security system [9,17,15,21]. The sickness certification tasks also include interactions with other stakeholders, but physicians have reported problems in cooperating with stakeholders within or outside the healthcare system [17,18,9,21,7]. The stakeholders comprise the healthcare, legal (social insurance office), workplace (employer or employment agency), and personal systems (the patient) [22].…”

“…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]. The sickness certification is then based on the patient's description of his or her symptoms and work situation [17][18][19]. The challenges physicians face in sickness certifications may come from insufficient competence to assess work ability [10,7,20] as well as scarce knowledge about workplaces, the labour market, and the social security system [9,17,15,21].…”

“…When there is a need for sick leave the physician together with the patient considers the advantages and the disadvantages of being on sick leave, determines the grade (full-time or part-time) and duration of sick leave, and what actions that need to be taken during the sick leave period in terms of investigations, treatments and rehabilitation interventions [3]. Previous research has shown that physicians belief that sickness certifications would benefit of involvement of other healthcare professions [18,10,8,23] and that physiotherapists [24,23] and occupational therapists [25] feel they have the competence to participate in work ability assessments. The few studies investigating the team members' roles indicate however an ambiguity in the team whether other healthcare professionals are supposed to work with work ability assessments [26].…”