Sick leave for patients with severe subjective health complaints. Challenges in general practice
Year: 2013
Type: dissertation
Study design: Observational Study
Abstract: The main purpose of this thesis was to contribute to a better understanding of factors that are important when general practitioners (GPs) make decisions for sick leave for patients with severe subjective health complaints (SHC). The thesis includes three papers that all deal with different aspects of this topic. The first paper describes which diagnoses GPs in Scandinavia apply for patients with severe SHC. In the second paper, factors important for sick leave decisions in this group of patient are explored. The third paper deals with GPs’ arguments for not wanting to participate in a study where patients would be randomized to sick leave. Paper I and II are based on a questionnaire from a cross sectional study in Norway, Sweden and Denmark where GPs watched dramatized video vignettes of a GP encounter of patients with severe SHC. Paper III is a qualitative study with webbased written responses from Norwegian GPs to an open-ended question about why they were unwilling to participate in the trial. GPs in Scandinavia applied a large variety of diagnoses to the same patients, but the diagnosis was not the fundamental factor determining sick leave decisions. Sick leave decisions were based on assessment of the patient’s work-ability and risk of deterioration if they continued working. Diagnostics and sick leave decisions in patients with severe SHC are complex and individualized tasks, also based on the GP’s knowledge about a patient’s personality, vulnerability, and family situation. These assessments require professional clinical skills of a GP, but deciding on sick leave in the end seems to be a joint decision between the GP and the patient. The findings in this thesis shed light on the GPs’ dilemmas of the potentially conflicting roles of being a gatekeeper for the society versus being an advocate for the patients. Since the primary diagnosis on the sick leave certificate forms the basis for national sick leave statistics the variance in these diagnoses affects the reliability of these statistics.
Author: Silje Mæland
Language: English
Subfield: Family Practice
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W17996282