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

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.

The Doctor as Parent, Partner, Provider… or Comrade? Distribution of Power in Past and Present Models of the Doctor–Patient Relationship

The 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.

Multimorbidity and fit note receipt in working-age adults with long-term health conditions

Background Research on sickness absence has typically focussed on single diagnoses, despite increasing recognition that long-term health conditions are highly multimorbid and clusters comprising coexisting mental and physical conditions are associated with poorer clinical and functional outcomes. The digitisation of sickness certification in the UK offers an opportunity to address sickness absence in a large primary care population. Methods Lambeth Datanet is a primary care database which collects individual-level data on general practitioner consultations, prescriptions, Quality and Outcomes Framework diagnostic data, sickness certification (fit note receipt) and demographic information (including age, gender, self-identified ethnicity, and truncated postcode). We analysed 326 415 people's records covering a 40-month period from January 2014 to April 2017. Results We found significant variation in multimorbidity by demographic variables, most notably by self-defined ethnicity. Multimorbid health conditions were associated with increased fit note receipt. Comorbid depression had the largest impact on first fit note receipt, more than any other comorbid diagnoses. Highest rates of first fit note receipt after adjustment for demographics were for comorbid epilepsy and rheumatoid arthritis (HR 4.69; 95% CI 1.73–12.68), followed by epilepsy and depression (HR 4.19; 95% CI 3.60–4.87), chronic pain and depression (HR 4.14; 95% CI 3.69–4.65), cardiac condition and depression (HR 4.08; 95% CI 3.36–4.95). Conclusions Our results show striking variation in multimorbid conditions by gender, deprivation and ethnicity, and highlight the importance of multimorbidity, in particular comorbid depression, as a leading cause of disability among working-age adults.

Physicians’ use of information from sickness certification guidelines: A nationwide Swedish survey

Background Sickness certification guidelines, introduced in Sweden 2007, are to support physician’s work with sickness certification of patients. Our aim was to explore the clinical importance of the guidelines, by studying what kind of information from guidelines the physicians use, and if this differ between type of clinics. Methods Data from a questionnaire sent to all 34 718 physicians in Sweden in 2017 were used (54% response rate). The study is based on answers from the 13 750 physicians who had sick-leave consultations. Results Half of the respondents used the guidelines at least once a month, and this was most common in primary healthcare (72%), occupational health services (64%) and psychiatry (61%). The type of information used differed; 53% used recommendations about suggested sick-leave duration and 29% about degree (full- or part-time) of sickness absence. Using information about function respectively work capacity was more common within psychiatry (42 and 42%), primary healthcare (37 and 38%) and occupational health services (35 and 41%) and less common among physicians in surgery and orthopaedic clinics (12 and 12%) who more often used information about duration (48 and 53%). In total, 74% reported that the guidelines to some extent were problematic to apply while 29% reported that they improved the quality of how they handled sickness certification tasks. Half (47%) experienced that the guidelines facilitated their contacts with patients. Conclusions The use of sickness certification guidelines varied between type of clinic and a majority experienced to some extent that the guidelines were problematic to apply. Further studies are needed to assess what information physicians in different settings need and what developments of the guidelines that are warranted. Key messages Half of the physicians used the sickness certification guidelines every month, but the type of information used varied with type of clinical setting. As many as half of the physicians stated that the sickness certification guidelines facilitated their contacts with patients, but a majority found them somewhat problematic to apply.