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- Engblom, Monika, et al.
(författare)
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When physicians get stuck in sick-listing consultations : A qualitative study of categories of sick-listing dilemmas
- 2010
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Ingår i: Work. - 1051-9815 .- 1875-9270. ; 35:2, s. 137-142
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Many physicians find sick-listing tasks problematic. The aim of this study was to identify categories of dilemmas experienced by physicians in their sick-listing practice. Design and subjects: Data was collected at courses that were aimed at improving physicians' sick-listing skills, arranged in different parts of Sweden. Before the course the participants, general practitioners (GP) sent in a written report of a sick-listing case they found problematic. The material consisted of group discussions of some 100 case reports from GPs. The process of categorisation of the dilemmas was a one-step, straightforward qualitative analysis. Results: Eight different categories of sick-listing dilemmas experienced by the physicians were identified. Examples of them are "Not the doctors' pigeon" (when the patients' problem was perceived as not being medical in nature), "Diagnosis as disguise" (when there is a discrepancy between how the patient describes the problems and what the physician apprehends), and "Harmed by sick listing - reversible" (when the physician perceives that the main problem is the iatrogenic adverse effects of sick listing per se). Implications: The contribution of the study is to provide understanding of and labels to the specific difficulties experienced by physicians in their sick-listing practice face to face with patients.
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- Norrmén, Gunilla, et al.
(författare)
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How primary health care physicians make sick listing decisions : the impact of medical factors and functioning
- 2008
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Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 9, s. 3-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The decision to issue sickness certification in Sweden for a patient should be based on the physician's assessment of the reduction of the patient's work capacity due to a disease or injury, not on psychosocial factors, in spite of the fact that they are known as risk factors for sickness absence. The aim of this study was to investigate the influence of medical factors and functioning on sick listing probability.METHODS: Four hundred and seventy-four patient-physician consultations, where sick listing could be an option, in general practice in Orebro county, central Sweden, were documented using physician and patient questionnaires. Information sought was the physicians' assessments of causes and consequences of the patients' complaints, potential to recover, diagnoses and prescriptions on sick leave, and the patients' view of their family and work situation and functioning as well as data on the patients' former and present health situation. The outcome measure was whether or not a sickness certificate was issued. Multivariate analyses were performed.RESULTS: Complaints entirely or mainly somatic as assessed by the physician decreased the risk of sick listing, and complaints resulting in severe limitation of occupational work capacity, as assessed by the patient as well as the physician, increased the risk of sick listing, as did appointments for locomotor complaints. The results for patients with infectious diseases or musculoskeletal diseases were partly similar to those for all diseases.CONCLUSION: The strongest predictors for sickness certification were patient's and GP's assessment of reduced work capacity, with a striking concordance between physician and patient on this assessment. When patient's complaints were judged to be non-somatic the risk of sickness certification was enhanced.
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- Norrmén, Gunilla, et al.
(författare)
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Impact of physician-related factors on sickness certification in primary health care
- 2006
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 24:2, s. 104-109
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate what factors are associated with physicians' decisions on whether or not to sickness certify the patient at a consultation. DESIGN: Questionnaire survey sent to physicians in general practice and their patients. SETTING: General practitioners in Orebro county, central Sweden. SUBJECTS: Sixty-five physicians with up to 10 patients each. MAIN OUTCOME MEASURE: Whether a sickness certificate was issued. RESULTS: Physicians with long experience in family medicine and those working part time issued more sickness certificates when all encounters with patients were considered. When only musculoskeletal problems were studied physicians with long experience or who were trained in social insurance medicine as undergraduates issued more sickness certificates. When only appointments for infections were studied, part-time physicians issued more sickness certificates. No impact of the physicians' sex on sickness certifying was found. CONCLUSIONS: Length of professional experience and physicians' working time appear to influence practices in sickness certifying.
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- Norrmén, Gunilla, 1944-, et al.
(författare)
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Influence on sickness certification of opinions and attitudes towards health related and insurance system related matters among general practitioners and their patients
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The aim of this study was to evaluate the influence of patients’ and physicians’ opinions and attitudes towards health related and insurance system related matters on sickness certification in primary health care. Methods: 474 patient-physician consultations in general practice in Örebro county, central Sweden, in which sickness certification was an option were documented using physician and patient questionnaires. The outcome measure was whether or not a sickness certificate was issued. Possible determinants were variables indicating the patient’s and the physician’s extent of agreement with statements concerning health and social insurance matters. Results: GPs and their patients took a fairly similar view to the statements. After multivariate analysis, attitudes expressed by the GPs’ were significantly more frequently related to their decision to sick certify or not, than were patients’ attitudes on the same items. The variables with the strongest impact were found when GPs expressed confidence in physicians’ knowledge of working life and when patients’ gave credit to employers’ willingness to keep disabled people in work. Such attitudes were in general associated with less sickness certification. Patients with musculoskeletal diseases, having met a GP who meant that patients should be allowed sick leave when not mentally well, were more often sick certified. Conclusions: Opinions among GPs and patients influence on sickness certification risk in several ways. GPs’ opinions seem to have a greater impact than patients’ on the GPs’ decision to sick certify a patient or not.
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| 7. |
- Norrmén, Gunilla, 1944-, et al.
(författare)
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The association of patient's family, leisure time, and work situation with sickness certification in primary care in Sweden
- 2010
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 28:2, s. 76-81
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate associations between patients’ family, leisure time and work related factors and physicians' measure whether or not to sickness certify the patient in connection with the consultation. Design: Questionnaire survey to physicians in general practice and their patients. Setting: General practitioners (GPs) and their patients in Örebro county, Sweden. Subjects: 474 patient-physician consultations from 65 physicians with up to ten patients each. Main outcome measure: Whether or not a sickness certificate was issued. Results: Among work related factors, high ‘authority over decisions’ and high "social support" correlated with 30% or more reduced sickness certification probability. Worrying about becoming ill or being injured from work correlates to almost doubled sickness certification risk. Among family and leisure time variables, only living with a common law partner and having no children correlated to increased sickness certification risk. In addition to analyses of the whole group (all diagnoses), the two largest diagnostic subgroups, infectious diseases and musculoskeletal diseases, were examined. For the infectious diseases subgroup, high demands in work correlated to increased sickness certification risk, while in the musculoskeletal diseases subgroup, worry about work related injury or illness was the main factor correlating to increased risk for sickness certification. Conclusions: Work related factors were the most important factors related to sickness certification in this study. Determinants for sickness certification risk differed between diagnostic subgroups.
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- Norrmén, Gunilla, 1944-
(författare)
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To be or not to be Sick Certified with Special Reference to Physician and Patient Related Factors
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives The aim of this thesis was to assess the importance of general practitioners (GP) and patient related factors for the GPs’ decision to sick certify or not to sick certify the patients. Study population and methods The data were obtained from a cross-sectional questionnaire study of GP-patient consultations. 65 GPs responded to one questionnaire about themselves and one questionnaire about each of the altogether 642 consultations. The patients responded to a questionnaire about themselves and the consultation, altogether 521 consultations. Various combinations of the three questionnaires were used in the four papers on which this thesis is based. Results Among GPs, long experience of family medicine and working part-time were significant determinants for issuing more sick leave certificates. Complaints perceived as clearly somatic by the physician decreased the chance of sick certifications, and complaints resulting in severe limitation of occupational work capacity, as assessed by the patient as well as the physician, increased the chance of sick certification, as did appointments for loco-motor complaints. Among work related factors, high ‘authority over decisions’ and high ‘social support’ were associated with reduced sickness certification probability. Worrying about illness or injury risks from work increased sickness certification. GPs and their patients took a fairly similar view to statements on health related and insurance system related matters. GPs’ opinions seem to have a greater impact than patients’ on the GPs’ decision to sickness certify a patient or not. Conclusions A number of patient and GP related factors were associated with the probability of getting sick certified. The patient’s own judgement of impaired work ability was important for sickness certification, but a shared judgement and decision between the GP and the patient appears probable in most cases.
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