Sickness certification challenges the physician

Difficulties in assessing the patients work capacity, non-medical problems, and handling situations in which the patients have different opinions about the need for sick leave are some of the challenges that physicians meet in their daily work, according to a new doctoral thesis from Karolinska Institutet.

Physicians play an essential role in the sickness absence process, and many of them experience related tasks as problematic. The overall aim of the current thesis by Dr Monika Engblom was to improve the understanding of sickness certification experienced as problematic by physicians in general practice and occupational health services, and to gain more knowledge about the frequency and severity of those problems. Four studies were conducted, two of which were based on written cases reports by Swedish physicians, one on discussions of those reports, and one on questionnaire data. All information about the patients was made anonymous.

The results showed that two thirds of the patients had been on sick leave for more than a year. It was also found that the most common type of cases concerned women, who were employed in non-qualified nursing occupations and were on sick leave due to psychiatric diagnoses. Furthermore, the most common measures taken by the physician were referrals to a psychotherapist and/or physiotherapist, and prescribing antidepressants.

In their written case reports, the physicians' personal and emotional involvement and their relations with the patient were visible to varying extents. Examples of situations reported as challenging were when the patients' problem was perceived as not being medical in nature, when there was a discrepancy between how the patient described the problems and what the physician apprehended, and when the physician perceived that the main problem was the iatrogenic adverse effects of sick leave per se.