Skip to main content

Advertisement

Log in

Education and Benchmarking Among Physicians May Facilitate Sick-Listing Practice

  • Published:
Journal of Occupational Rehabilitation Aims and scope Submit manuscript

Abstract

Introduction Assessing work ability and sickness certification are considered problematic by many physicians and education and implementation of guidelines to improve knowledge and skills has been requested. Our aim was to study the association between such interventions and physicians’ sick-listing practices. Methods A web-based questionnaire was sent to all physicians working in primary care, psychiatry, orthopedics/rheumatology in the southern region of Sweden before (in 2007 to 1,063 physicians) and after (in 2009 to 1,164 physicians) educational interventions in insurance medicine were offered. Results With a response rate of 58%, half of the physicians (51%) reported to work at a clinic with a sick-listing policy in 2009 compared with 31% in 2007. Primary care physicians (OR 12.4) and physicians who had participated in educational interventions in insurance medicine (OR 2.4) more often had a sick-listing policy at the clinic. Physicians with a longer medical experience (OR 0.7) and those with support at the clinic (OR 0.3) and the possibility to extend time if needed (OR 0.4) were less likely to report of problematic cases while primary care physicians were (OR 2.9). On the contrary, physicians who reported to rarely have the possibility to extend time when handling problematic cases were more likely to issue a higher number of sickness certificates. Conclusions The sick-listing process is often viewed as problematic and more often by primary care physicians. Benchmarking and education in insurance medicine together with the possibility to allocate extra time if encountering problematic cases may facilitate sick-listing practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Stone DA. Physicians as gatekeepers: illness certification as a rationing device. Public Policy. 1979;27(2):227–54.

    PubMed  CAS  Google Scholar 

  2. Arrelov B, Alexanderson K, Hagberg J, Lofgren A, Nilsson G, Ponzer S. Dealing with sickness certification—a survey of problems and strategies among general practitioners and orthopaedic surgeons. BMC Public Health. 2007;7(147):273.

    Article  PubMed  Google Scholar 

  3. Wynne-Jones G, Mallen CD, Mottram S, Main CJ, Dunn KM. Identification of UK sickness certification rates, standardised for age and sex. Br J Gen Pract. 2009;59(564):510–6.

    Article  PubMed  Google Scholar 

  4. Bishop A, Foster NE, Thomas E, Hay EM. How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapists. Pain. 2008;135(1–2):187–95.

    Article  PubMed  Google Scholar 

  5. Persson G, Danielsson M, Rosen M, Alexanderson K, Lundberg O, Lundgren B, et al. Health in Sweden: the National Public Health Report 2005. Scand J Public Health Suppl. 2006;67:3–10.

    Article  PubMed  Google Scholar 

  6. Tellnes G. Days lost by sickness certification. Scand J Prim Health Care. 1989;7(4):245–51.

    Article  PubMed  CAS  Google Scholar 

  7. Wahlstrom R, Alexanderson K. Swedish council on technology assessment in health care (SBU). Chapter 11. Physicians’ sick-listing practices. Scand J Public Health Suppl. 2004;63:222–55.

    Article  PubMed  Google Scholar 

  8. Swartling MS, Alexanderson KA, Wahlstrom RA. Barriers to good sickness certification—an interview study with Swedish general practitioners. Scand J Public Health. 2008;36(4):408–14.

    Article  PubMed  Google Scholar 

  9. von Knorring M, Sundberg L, Lofgren A, Alexanderson K. Problems in sickness certification of patients: a qualitative study on views of 26 physicians in Sweden. Scand J Prim Health Care. 2008;26(1):22–8.

    Article  Google Scholar 

  10. Ilmarinen J. Work ability–a comprehensive concept for occupational health research and prevention. Scand J Work Environ Health. 2009;35(1):1–5.

    Article  PubMed  Google Scholar 

  11. Norrmen G, Svardsudd K, Andersson DK. How primary health care physicians make sick listing decisions: the impact of medical factors and functioning. BMC Fam Pract. 2008;9:3.

    Article  PubMed  Google Scholar 

  12. Stigmar K, Grahn B, Ekdahl C. Work ability–experiences and perceptions among physicians. Disabil Rehabil. 2010;32(21):1780–9.

    Article  PubMed  Google Scholar 

  13. Money A, Hussey L, Thorley K, Turner S, Agius R. Work-related sickness absence negotiations: GPs’ qualitative perspectives. Br J Gen Pract. 2010;60(579):721–8.

    Article  PubMed  Google Scholar 

  14. Hussey S, Hoddinott P, Wilson P, Dowell J, Barbour R. Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland. BMJ. 2004;328(7431):88.

    Article  PubMed  Google Scholar 

  15. Lofgren A, Hagberg J, Arrelov B, Ponzer S, Alexanderson K. Frequency and nature of problems associated with sickness certification tasks: a cross-sectional questionnaire study of 5455 physicians. Scand J Prim Health Care. 2007;25(3):178–85.

    Article  PubMed  Google Scholar 

  16. Wynne-Jones G, Mallen CD, Main CJ, Dunn KM. Sickness certification and the GP: what really happens in practice? Fam Pract. 2010;27(3):344–50.

    Article  PubMed  CAS  Google Scholar 

  17. Roope R, Parker G, Turner S. General practitioners’ use of sickness certificates. Occup Med (Lond). 2009;59(8):580–5.

    Article  Google Scholar 

  18. Englund L, Tibblin G, Svardsudd K. Variations in sick-listing practice among male and female physicians of different specialities based on case vignettes. Scand J Prim Health Care. 2000;18(1):48–52.

    Article  PubMed  CAS  Google Scholar 

  19. Norrmen G, Svardsudd K, Andersson D. Impact of physician-related factors on sickness certification in primary health care. Scand J Prim Health Care. 2006;24(2):104–9.

    Article  PubMed  Google Scholar 

  20. Swartling MS, Hagberg J, Alexanderson K, Wahlstrom RA. Sick-listing as a psychosocial work problem: a survey of 3997 Swedish physicians. J Occup Rehabil. 2007;17(3):398–408.

    Article  PubMed  Google Scholar 

  21. Gerner U, Alexanderson K. Issuing sickness certificates: a difficult task for physicians: a qualitative analysis of written statements in a Swedish survey. Scand J Public Health. 2009;37(1):57–63.

    Article  PubMed  Google Scholar 

  22. Socialstyrelsen (The National Board of Health and Welfare). Försäkringsmedicinskt beslutstöd (National Guidelines). Available from http://www.socialstyrelsen.se/riktlinjer/forsakringsmedicinsktbeslutsstod.

  23. Alexanderson KA. Läkares arbete med sjukskrivning (Physician’s sick-listing practice). Report 2009, Karolinska Institutet. 2009.

  24. Altman C. Practical statistics for medical research. London: Chapman & Hall; 1991.

    Google Scholar 

  25. Reed P. The medical disability advisor. Workplace guidelines for disability duration. Singapore: Reed group holdings Ltd.; 2004.

    Google Scholar 

  26. Reed M, Devers K, Landon B. Physicians and care management: more acceptance than you think. Issue Brief Cent Stud Health Syst Change. 2003; (60):1–4.

  27. Satterlee WG, Eggers RG, Grimes DA. Effective medical education: insights from the Cochrane library. Obstet Gynecol Surv. 2008;63(5):329–33.

    Article  PubMed  Google Scholar 

  28. Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev (Online). 2009; (2): CD003030.

  29. Lofgren A, Hagberg J, Alexanderson K. What physicians want to learn about sickness certification: analyses of questionnaire data from 4019 physicians. BMC Public Health. 2010;10:61.

    Article  PubMed  Google Scholar 

  30. Wynne-Jones G, Mallen CD, Main CJ, Dunn KM. What do GPs feel about sickness certification? A systematic search and narrative review. Scand J Prim Health Care. 2010;28(2):67–75.

    Article  PubMed  Google Scholar 

  31. Soderberg E, Alexanderson K. Sickness certification practices of physicians: a review of the literature. Scand J Public Health. 2003;31(6):460–74.

    Article  PubMed  Google Scholar 

  32. Alexanderson K, Brommels M, Ekenvall L, Karlsryd E, Löfgren A, Sundberg L, et al. Problem inom hälso- och sjukvården kring handläggning av patienters sjukskrivning. (Problems in health care regarding management of patietns’ sickness certification). Stockholm, Karolonska Institutet. 2005.

  33. Hamberg K, Risberg G, Johansson EE. Male and female physicians show different patterns of gender bias: a paper-case study of management of irritable bowel syndrome. Scand J Public Health. 2004;32(2):144–52.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Thanks to all physicians who answered the questionnaire. We would also like to thank Louise Roberts and Ronny Wain for excellent technical support with the web based questionnaire and Ulf Hallgårde for valuable input and support.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. B. Bremander.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bremander, A.B., Hubertsson, J., Petersson, I.F. et al. Education and Benchmarking Among Physicians May Facilitate Sick-Listing Practice. J Occup Rehabil 22, 78–87 (2012). https://doi.org/10.1007/s10926-011-9321-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10926-011-9321-5

Keywords

Navigation