Views on Sick-listing Practice Among Swedish General Practitioners--a Phenomenographic Study

Overview

Journal BMC Fam Pract

Publisher Biomed Central

Specialties Health Services
Public Health

Date 2007 Aug 1

PMID 17663793

Citations 16

Authors

Malin Swartling

Stefan Peterson

Rolf Wahlstrom

Affiliations

Soon will be listed here.

Abstract

Background: The number of people on sick-leave started to increase in Sweden and several other European countries towards the end of the 20th 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.

Methods: Semi-structured interviews with 19 GPs in 17 Primary Health Care settings in four mid-Sweden counties. Interview transcripts were analysed with phenomenographic approach aiming to uncover the variation in existing views regarding the respondents' sick-listing commission and practice.

Results: We found large qualitative differences in the GPs' views on sick-listing. The sick-listing commission was experienced to come either from society or from patients, with no responsibility for societal interests, or as an integration of these two views. All the GPs were aware of a possible conflict between the interests of society and patients. While some expressed feelings of strong conflict, others seemed to have solved the conflict, at least partly, between these two loyalties. Some GPs experienced carrying the full responsibility to decide whether a patient would get monetary sick-leave benefits or not and they were not comfortable with this situation. Views on the physician's and the patient's responsibility in sick-listing and rehabilitation varied from a passive to an empowering role of the physician. GPs expressing a combination of less inclusive views of the different aspects of sick-listing experienced strong conflict and appeared to feel distressed in their sick-listing role. Some GPs described how they had changed from less to more inclusive views.

Conclusion: The clearer understanding of the different views on sick-listing generated in this study can be used in educational efforts to improve physicians' sick-listing practices, benefiting GPs' work situation as well as their patients' well-being. The GP's role as a gatekeeper in the social security system needs further exploration. Our findings could be used to develop a questionnaire to measure the distribution of different views in a wider population of GPs.

Citing Articles

Assessing work capacity - reviewing the what and how of physicians' clinical practice.

Nordling P, Priebe G, Bjorkelund C, Hensing G BMC Fam Pract. 2020; 21(1):72.

PMID: 32340611 PMC: 7187489. DOI: 10.1186/s12875-020-01134-9.

Neurologists dealing with sickness certification: Experiences of problems and need of competence.

Snoljung A, Karrholm J, Hinas E, Alexanderson K Brain Behav. 2017; 7(11):e00845.

PMID: 29201546 PMC: 5698863. DOI: 10.1002/brb3.845.

General practitioners' perceptions of working with the certification of sickness absences following changes in the Swedish social security system: a qualitative focus-group study.

Carlsson L, Lannerstrom L, Wallman T, Holmstrom I BMC Fam Pract. 2015; 16:21.

PMID: 25888369 PMC: 4339246. DOI: 10.1186/s12875-015-0238-5.

Predicting return to work among sickness-certified patients in general practice: properties of two assessment tools.

von Celsing A, Svardsudd K, Wallman T Ups J Med Sci. 2014; 119(3):268-77.

PMID: 24873686 PMC: 4116767. DOI: 10.3109/03009734.2014.922143.

Health care management of sickness certification tasks: results from two surveys to physicians.

Lindholm C, von Knorring M, Arrelov B, Nilsson G, Hinas E, Alexanderson K BMC Res Notes. 2013; 6:207.

PMID: 23701711 PMC: 3671141. DOI: 10.1186/1756-0500-6-207.

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