Physician’s work with sickness certification of patients; results from 4 very large Swedish surveys

AbstractThe commonly occurring metaphors and models of the doctor–patient relationship can be divided into three clusters, depending on what distribution of power they represent: in the paternalist cluster, power resides with the physician; in the consumer model, power resides with the patient; in the partnership model, power is distributed equally between doctor and patient. Often, this tripartite division is accepted as an exhaustive typology of doctor–patient relationships. The main objective of this paper is to challenge this idea by introducing a fourth possibility and distribution of power, namely, the distribution in which power resides with neither doctor nor patient. This equality in powerlessness—the hallmark of “the age of bureaucratic parsimony”—is the point of departure for a qualitatively new doctor–patient relationship, which is best described in terms of solidarity between comrades. This paper specifies the characteristics of this specific type of solidarity and illustrates it with a case study of how Swedish doctors and patients interrelate in the sickness certification practice.

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Sickness-certification practice in different clinical settings; a survey of all physicians in a country

BMC Public Health ◽

10.1186/1471-2458-10-752 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 29

Author(s):

Christina Lindholm ◽

Britt Arrelöv ◽

Gunnar Nilsson ◽

Anna Löfgren ◽

Elin Hinas ◽

...

Keyword(s):

Clinical Settings ◽

Sickness Certification

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Physicians’ experiences with sickness absence certification in Finland

Scandinavian Journal of Public Health ◽

10.1177/1403494818758817 ◽

2018 ◽

Vol 47 (8) ◽

pp. 859-866 ◽

Cited By ~ 3

Author(s):

Katariina Hinkka ◽

Mikko Niemelä ◽

Ilona Autti-Rämö ◽

Heikki Palomäki

Keyword(s):

Sickness Absence ◽

Social Insurance ◽

Waiting Times ◽

Practice Setting ◽

Sickness Certification ◽

National Guidelines ◽

Know How ◽

Rehabilitation System ◽

Clinical Practice Setting ◽

Working Age

Aims: The aim of this study was to explore Finnish physicians’ perceptions of sickness absence (SA) certification. Methods: A questionnaire was sent to 50% of the physicians in Finland who provide care to working-age patients in a clinical practice setting. Of the 8867 physicians, 3089 responded. Physicians handling SA certification patients at least a few times per month were included ( n = 2472). Results: At least a few times per month, 61% of all physicians perceived SA issues as problematic, 60% had experienced a lack of time in dealing with SA matters, 36% had disagreed with a patient on SA certification, and 36% had met a patient who wanted a SA certificate for reasons other than a disease or injury. Physicians were least worried about patients filing complaints (4%), exhibiting threatening behaviour (2%), or switching physicians for SA certification reasons (1%). A total of 60% of physicians had prescribed SA for a longer period than necessary because of long waiting times for further care/measures. Non-specialized physicians, general practitioners, and psychiatrists experienced problems more frequently than surgeons and occupational health physicians. Over 50% of the respondents had a fairly large or very large need to deepen their knowledge of social insurance matters. The need for national guidelines for all or some diseases was reported by 80% of the respondents. Conclusions: Many physicians perceive SA tasks as problematic and are unable to dedicate enough time to them. Shortcomings in physicians’ sickness certification know-how, as well as obstacles in the healthcare and rehabilitation system, prolong the SA process. Attitudes towards the adoption of national guidelines on the duration of SA were positive.

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Tussles and Rollovers: Negotiating Sickness Certification in Primary Care

Advances in Applied Sociology ◽

10.4236/aasoci.2014.412029 ◽

2014 ◽

Vol 04 (12) ◽

pp. 247-260 ◽

Cited By ~ 3

Author(s):

Paula Byrne ◽

Adele Ring ◽

Peter Salmon ◽

Chris Dowrick ◽

Mark Gabbay

Keyword(s):

Primary Care ◽

Sickness Certification

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Physician’s use of sickness certification guidelines: a nationwide survey of 13 750 physicians in different types of clinics in Sweden

BMJ Open ◽

10.1136/bmjopen-2021-051555 ◽

2021 ◽

Vol 11 (12) ◽

pp. e051555

Author(s):

Veronica Svärd ◽

Kristina Alexanderson

Keyword(s):

Occupational Health ◽

Health Services ◽

Sick Leave ◽

Primary Healthcare ◽

Work Capacity ◽

Occupational Health Services ◽

Sickness Certification ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Different Types

ObjectivesTo explore physicians’ experiences of using the national sickness certification guidelines introduced in 2007 and the types of information they used, in general and in different types of clinics.DesignCross-sectional survey.SettingMost physicians working in Sweden in 2017.ParticipantsA questionnaire was sent to 34 718 physicians; 54% responded. Analyses were based on answers from the 13 750 physicians who had sick leave cases.Outcome measuresTo what extent the guidelines were used and what type of information from them that was used.ResultsTen years after the sickness certification guidelines were introduced in Sweden, half of the physicians used them at least once a month. About 40% of physicians in primary healthcare and occupational health services used the guidelines every week. The type of information used varied; 53% used recommendations about duration and 29% about degree of sick leave. Using information about function and activity/work capacity, respectively, was more common within primary healthcare (37% and 38%), psychiatry (42% and 42%), and occupational health services (35% and 41%), and less common in surgery and orthopaedic clinics (12% and 12%) who more often used information about duration (48% and 53%). Moreover, 10% stated that the guidelines were very, and 24% fairly problematic to apply. Half (47%) stated that the guidelines facilitated their contacts with patients and 29% that they improved quality in their management of sick leave cases. More non-specialists, compared with specialists, found that the guidelines facilitated contacts with patients (OR 3.28, 95% CI 3.04 to 3.55).ConclusionsThe majority of the physicians used the sickness certification guidelines, although this varied with type of clinic. Half stated that the guidelines facilitated patient contacts. Yet, some found it problematic to apply the guidelines. Further development of the guidelines is warranted as well as more knowledge about them among physicians.

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