Sickness absence during the last decades has become a growing problem in many countries.1
The role of the physicians in the sickness absence process has been highlighted, and several interventions to increase the quality of their work with sickness certification have been undertaken in many countries.3–7
In some studies, all cross-sectional, it has been revealed that physicians, especially general practitioners (GPs), experience sickness certification matters as problematic.8–15
In a systematic review about GPs' attitudes towards sickness certification, the problems identified from the 18 included studies were classified into three themes: conflicts (eg, between physician and patient), role responsibilities (eg, unclear and/or conflicting roles) and barriers to good practice (both within and outside the healthcare system).8
A study of the GPs and orthopaedic surgeons (n=822) in two Swedish counties found that they state the following as problematic: handling of disagreement with patients regarding the need for sickness certification, consultations involving prolongation of sick-leave spells initiated by a colleague and assessing work capacity and that the GPs in general had higher ORs for experiencing such problems.9
Obstetricians (n=39) find handling of disagreement with patients regarding the need for sickness certification as a problem.13
Löfgren et al10
revealed yet another problematic issue for physicians (n=5455), deciding optimal duration and degree of sick leave and that this varied much with type of specialty/work clinic. In another study, we found that physicians (n=14 210) find it problematic to assess patient's work capacity and to provide a prognosis regarding duration of work capacity.11
A Norwegian study (n=308) found large differences regarding the perceptions towards sickness certification between groups of GPs.12
In a qualitative study, Hussey et al14
found that 67 GPs in the UK often experienced great problems related to sickness certification and contradictory demands from stakeholders. Edlund and Dahlgren15
found in a Swedish qualitative study that the dominating experiences regarding sickness certification among the physicians interviewed (n=14) were diminished control, lack of time and increased demands. None of these studies include to what extent these tasks are experienced as work environmental problems (WEP). However, some problems related to sickness certification tasks (SCT) can be considered to be emotionally straining for physicians.14
For instance, in the former study (n=3997), around 10% of the included GPs felt threatened by a patient and/or was worried about getting reported to the disciplinary board at least once a month.16
In Sweden, you need a medical certificate issued by a physician after the seventh day of a sick-leave spell. This certificate is the bases for decision of the employer or, after 2 weeks of sick leave, the Social Insurance Office (SIO) regarding if the person fulfils the criteria for sickness benefits. In consultations where sickness absence is considered, a physician has several tasks. In most Western countries, these tasks involve the following: to ascertain whether the disease or injury impairs the patient's functional ability to the extent that the work capacity is also impaired in relation to her or his work demands; consider, together with the patient, the possible advantages and disadvantages of being sickness absent; determine the duration of sick leave and the medical investigations, treatments or other measures needed during the sick-leave period; determine if contact with other specialists, the SIO, occupational health services, the employer or other stakeholders is needed and if so, to establish adequate communication; issue a certificate that provides sufficient information for the employer or social insurance officer to decide whether the patient is entitled to sickness benefits and in need of further return-to-work measures and document assessments and actions taken.18
In a previous study (unpublished data), we concluded that half of the Swedish physicians aged <65 years, having with sickness certification consultations at least a few times a year, and who responded on a survey sent to all physicians working in Sweden experienced SCT as a WEP. Moreover, 11% even did this to a great extent. There were great differences between work clinics in these proportions; the highest were found among physicians working in primary care (GPs), psychiatry and orthopaedics. Work environment is a generic term for biological, medical, physiological, psychological, social and technological factors in the work situation or in the workplace environment that affect the individual. A person's experience of his or her work environment concerns the situation in general. Problems regarding specific work tasks can, on the other hand, be experienced without experiencing the work with those aspects as a WEP. On the contrary, professionals can even experience problems as stimulating.
The aim of the present study was to examine (1) what the minority of physicians who perceive SCT to a great extent as a WEP experience as problematic, (2) if these problem areas were correlated, and (3) if there were differences in stated problem areas between GPs, psychiatrists, orthopaedists and physicians working at other types of clinics.