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BMC Primary Care
Published in: BMC Primary Care 1/2007

Open Access 01-12-2007 | Research article

Views on sick-listing practice among Swedish General Practitioners – a phenomenographic study

Authors: Malin Swartling, Stefan Peterson, Rolf Wahlström

Published in: BMC Primary Care | Issue 1/2007

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Abstract

Background

The number of people on sick-leave started to increase in Sweden and several other European countries towards the end of the 20th century. Physicians play an important role in the sickness insurance system by acting as gate-keepers. Our aim was to explore how General Practitioners (GPs) view their sick-listing commission and sick-listing practice.

Methods

Semi-structured interviews with 19 GPs in 17 Primary Health Care settings in four mid-Sweden counties. Interview transcripts were analysed with phenomenographic approach aiming to uncover the variation in existing views regarding the respondents' sick-listing commission and practice.

Results

We found large qualitative differences in the GPs' views on sick-listing. The sick-listing commission was experienced to come either from society or from patients, with no responsibility for societal interests, or as an integration of these two views. All the GPs were aware of a possible conflict between the interests of society and patients. While some expressed feelings of strong conflict, others seemed to have solved the conflict, at least partly, between these two loyalties.
Some GPs experienced carrying the full responsibility to decide whether a patient would get monetary sick-leave benefits or not and they were not comfortable with this situation. Views on the physician's and the patient's responsibility in sick-listing and rehabilitation varied from a passive to an empowering role of the physician.
GPs expressing a combination of less inclusive views of the different aspects of sick-listing experienced strong conflict and appeared to feel distressed in their sick-listing role. Some GPs described how they had changed from less to more inclusive views.

Conclusion

The clearer understanding of the different views on sick-listing generated in this study can be used in educational efforts to improve physicians' sick-listing practices, benefiting GPs' work situation as well as their patients' well-being. The GP's role as a gatekeeper in the social security system needs further exploration. Our findings could be used to develop a questionnaire to measure the distribution of different views in a wider population of GPs.
Appendix
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Literature
1.
Wahlström R, Alexanderson K: Physicians' sick-listing practices. Sickness absence - causes, consequences and physicians' certification practice A systematic literature review by Swedish Council on Technology Assessment in Health Care (SBU). Edited by: Alexanderson K, Norlund A. 2004, Scand J Public Health , 32 : 222-255.
2.
Socialstyrelsen: Folkhälsorapport [Public Health Report]. 2005, Stockholm , Socialstyrelsen, 395-
3.
Alexanderson K, Norlund A: Aim, background, key concepts, regulations, and current statistics. Sickness absence - causes, consequences and physicians' certification practice A systematic literature review by Swedish Council on Technology Assessment in Health Care (SBU). Edited by: Alexanderson K, Norlund A. 2004, Scand J Public Health , 32 : 12-30.
4.
5.
Qin P, Agerbo E, Westergard-Nielsen N, Eriksson T, Mortensen PB: Gender differences in risk factors for suicide in Denmark. Br J Psychiatry. 2000, 177: 546-550. 10.1192/bjp.177.6.546.CrossRefPubMed
6.
Judiesch MK, Lyness KS: Left behind? The impact of leaves of absence on managers' career success. Acad Managem J. 1999, 42 (6): 641-651. 10.2307/256985.CrossRef
7.
Stone DA: Physicians as gatekeepers: Illness certification as a rationing device. Public Policy. 1979, 27 (2): 227-254.PubMed
8.
Peterson S, Eriksson M, Tibblin G: Practice variation in Swedish primary care. Scand J Prim Health Care. 1997, 15 (2): 68-75.CrossRefPubMed
9.
Englund L, Tibblin G, Svärdsudd 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. 10.1080/02813430050202569.CrossRefPubMed
10.
Arrelöv B, Borgquist L, Ljungberg D, Svärdsudd K: Do GPs sick-list patients to a lesser extent than other physician categories? A population-based study. Fam Pract. 2001, 18 (4): 393-398. 10.1093/fampra/18.4.393.CrossRefPubMed
11.
Englund L, Svärdsudd K: Sick-listing habits among general practitioners in a Swedish county. Scand J Prim Health Care. 2000, 18 (2): 81-86. 10.1080/028134300750018954.CrossRefPubMed
12.
Larsen BA, Forde OH, Tellnes G: Legens roll i sykmelding [Physician's role in certification for sick-leave]. Tidsskr Nor Laegeforen. 1994, 114 (12): 1442-1444.PubMed
13.
Timpka T, Hensing G, Alexanderson K: Dilemmas in sickness certification among Swedish physicians. Europ J Public Health. 1995, 5: 215-219. 10.1093/eurpub/5.3.215.CrossRef
14.
Chew-Graham C, May C: Chronic low back pain in general practice: the challenge of the consultation. Fam Pract. 1999, 16 (1): 46-49. 10.1093/fampra/16.1.46.CrossRefPubMed
15.
Swartling M, Alexanderson K, Hagström J, Wahlström R: Sick-listing as a psychosocial work problem – a survey of 3997 Swedish physicians. J Occup Rehab,. 2007, Jul 3; [Epub ahead of print]-
16.
Alexanderson K, Brommels M, Ekenvall L, Karlsryd E, Löfgren A, Sundberg L, Österberg M: Problem inom hälso- och sjukvården kring handläggning av patienters sjukskrivning [Problems within healthcare regarding managing patients' sick-listing]. 2005, Stockholm , Karolinska Institutet
17.
Löfgren A, Arrelov B, Hagberg J, Ponzer S, Söderberg E, 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.
18.
Wahlström R, Lagerløv P, Stalsby Lundborg C, Hummers-Pradier E, Veninga CCM, Dahlgren LO, Denig P, DEP-group: Variations in general practitioners' views of asthma management in four European countries. Soc Sci & Med. 2001, 53: 507-518. 10.1016/S0277-9536(00)00356-7.CrossRef
19.
Wahlström R, Dahlgren LO, Tomson G, Diwan VK, Beermann B: Changing primary care doctors' conceptions - a qualitative approach to evaluating an intervention. Adv Health Sci Educ. 1997, 2: 221-236. 10.1023/A:1009763521278.CrossRef
20.
Goodwin LD, Goodwin WL: Are validity and reliability "relevant" in qualitative evaluation research?. Eval Health Prof. 1984, 7 (4): 413-426. 10.1177/016327878400700403.CrossRefPubMed
21.
Dahlgren LO, Fallsberg M: Phenomenography as a qualitative approach in social pharmacy research. J Soc Adm Pharm. 1991, 8 (4): 153-156.
22.
Bowden JA, Walsh E: Phenomenographic Research: Variations in method. The Warburton symposium. 1994, Warburton, Australia , Royal Melbourne Institute of Technology (RMIT)
23.
Sandberg J: Understanding human competence at work. An interpretative approach. Acad Managem J. 2000, 43 (1): 9-17. 10.2307/1556383.CrossRef
24.
Dall'Alba G: Medical practice as characterised by beginning medical students. Adv Health Sci Educ. 1998, 3: 101-118. 10.1023/A:1009783602925.CrossRef
25.
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): 88-10.1136/bmj.37949.656389.EE.CrossRefPubMedPubMedCentral
26.
Gulbrandsen P, Aasland OG, Forde R: Legeattester for å hjelpe pasienten [Medical certificates issued to help the patient]. Tidsskr Nor Laegeforen. 2004, 124 (2): 192-194.PubMed
27.
Hensing G, Alexanderson K, Timpka T: Dilemmas in the daily work of social insurance officers. Scand J Soc Welfare. 1997, 6: 301-309. 10.1111/j.1468-2397.1997.tb00201.x.CrossRef
28.
Stålsby Lundborg C, Wahlström R, Dall'Alba G: Ways of experiencing asthma management. Variations among general practitioners in Sweden. Scand J Prim Health Care. 1999, 17 (4): 226-231. 10.1080/028134399750002458.CrossRef
29.
Hiscock J, Ritchie J: The GPs role in sickness certification. 2001, London , Department of Work and Pension
30.
Byrne P, Long B: Doctors talking to patients. 1976, London , HMSO
31.
Epstein RM, Franks P, Fiscella K, Shields CG, Meldrum SC, Kravitz RL, Duberstein PR: Measuring patient-centred communication in patient-physician consultations: Theoretical and practical issues. Soc Sci & Med. 2005, 61: 1516-1528. 10.1016/j.socscimed.2005.02.001.CrossRef
32.
Theorell T: Fighting for and losing control in life. Acta Physiol Scand Suppl. 1997, 640: 107-111.PubMed
33.
Davis DA, Thomson MA, Oxman AD, Haynes RB: Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995, 274 (9): 700-705. 10.1001/jama.274.9.700.CrossRefPubMed
34.
Thomson O'Brien MA, Oxman AD, Davis DA, Haynes RB, Freemantle N, Harvey EL: Educational outreach visits: effects on professional practice and health care outcomes (Cochrane Review). Cochrane Database Syst Rev. 2000, 2:
35.
Marton F: A research approach to investigating different understandings of reality. J Thought. 1986, 21 (3): 28-49.
36.
Fishbein M, Ajzen I: Belief, attitude, intention and behaviour: an introduction to theory and research. Addison-Wesley series in social psychology. 1975, Reading, Mass: Addison-Wesley
37.
Tellnes G, Sandvik L, Moum T: Inter-doctor variation in sickness certification. Scand J Prim Health Care. 1990, 8 (1): 45-52.CrossRefPubMed
38.
Gulbrandsen P, Hofoss D, Nylenna M, Saltyte-Benth J, Aasland OG: General practitioners' relationship to sickness certification. Scand J Prim Health Care. 2007, 25 (1): 20-26. 10.1080/02813430600879680.CrossRefPubMedPubMedCentral
39.
Sandberg J: Human competence at work - an interpretatative approach. Economic Sciences. 1994, Gothenburg , Göteborgs universitet, Phd:
40.
Hamberg K, Johansson E, Lindgren G, Westman G: Scientific rigour in qualitative research - examples from a study of women's health in family practice. Fam Pract. 1994, 11 (2): 176-181. 10.1093/fampra/11.2.176.CrossRefPubMed
41.
Sandberg J: Are phenomenographic results reliable?. J Nordic Educ Research. 1995, 15 (3): 156 -1561.
Metadata
Title
Views on sick-listing practice among Swedish General Practitioners – a phenomenographic study
Authors
Malin Swartling
Stefan Peterson
Rolf Wahlström
Publication date
01-12-2007
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2007
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-8-44

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