Skip to main content
Top
Published in: BMC Health Services Research 1/2012

Open Access 01-12-2012 | Research article

Psychiatrists′ work with sickness certification: frequency, experiences and severity of the certification tasks in a national survey in Sweden

Authors: Gunnar H Nilsson, Britt Arrelöv, Christina Lindholm, Therese Ljungquist, Linnea Kjeldgård, Kristina Alexanderson

Published in: BMC Health Services Research | Issue 1/2012

Login to get access

Abstract

Background

Many psychiatrists are involved in sickness certification of their patients; however, there is very limited knowledge about this aspect of their work. The objective of this study was to explore frequencies of problematic issues in the sickness certification tasks and experiences of severity regarding these problematic issues among psychiatrists.

Methods

A cross-sectional nationwide questionnaire study to all physicians in Sweden. The 579 specialists in psychiatry who answered the questionnaire, were under 65 years of age, worked mainly in psychiatric care, and had consultations involving sickness certification at least once a week were included.

Results

The frequency of problematic sickness certification consultations a few times per year or more often was considered by 87.3% of the psychiatrists; 11.7% handle such cases at least once a week. A majority (60.9%) reported ‘not having enough time with the patient’ at least once a week. The psychiatrists had access to several categories of professionals in their daily work. More than one third certified unnecessarily long sick-leave periods at least once a month due to waiting times for Social Insurance Office investigations or for treatments or investigations within health care.

Conclusion

The majority found it problematic to assess the level and duration of work incapacity, but also other types of problems like unnecessarily long sick-leave periods due to different types of waiting times. The findings have implications for different kinds of organisational and managerial support and training in sickness certification issues, like guidance to assess the level and duration of work incapacity.
Appendix
Available only for authorised users
Literature
1.
go back to reference Järvisalo J, Anderson B, Boedeker W, Houtman I: Mental disorders as a major challenge in prevention of work disability. 2005, Helsinki: Kela, Volume 66 Järvisalo J, Anderson B, Boedeker W, Houtman I: Mental disorders as a major challenge in prevention of work disability. 2005, Helsinki: Kela, Volume 66
3.
go back to reference Arrelöv B, Alexanderson K, Hagberg J, Löfgren 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.CrossRefPubMedPubMedCentral Arrelöv B, Alexanderson K, Hagberg J, Löfgren 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.CrossRefPubMedPubMedCentral
4.
go back to reference Wynne-Jones G, Mallen CD, Welsh V, Dunn KM: Rates of sickness certification in European primary care: A systematic review. Eur J Gen Pract. 2008, 14: 99-108. 10.1080/13814780802687521.CrossRefPubMed Wynne-Jones G, Mallen CD, Welsh V, Dunn KM: Rates of sickness certification in European primary care: A systematic review. Eur J Gen Pract. 2008, 14: 99-108. 10.1080/13814780802687521.CrossRefPubMed
5.
go back to reference Frances A: It′s not too late to save "normal". Los Angeles Times. 2010, March 01 Frances A: It′s not too late to save "normal". Los Angeles Times. 2010, March 01
6.
go back to reference Vingård E, Alexanderson K, Norlund A: Swedish Council on Technology Assessment in Health Care (SBU). Chapter 9. Consequences of being on sick leave. Scandinavian Journal of Public Health. 2004, 32 (Supplemet 63, Review): 207-215.CrossRef Vingård E, Alexanderson K, Norlund A: Swedish Council on Technology Assessment in Health Care (SBU). Chapter 9. Consequences of being on sick leave. Scandinavian Journal of Public Health. 2004, 32 (Supplemet 63, Review): 207-215.CrossRef
7.
go back to reference Floderus F, Göransson S, Alexanderson K, Aronsson G: Self-estimated life situation in patients on long-term sick leave. J Rehabil Med. 2005, 37: 291-299. 10.1080/16501970510034422.CrossRefPubMed Floderus F, Göransson S, Alexanderson K, Aronsson G: Self-estimated life situation in patients on long-term sick leave. J Rehabil Med. 2005, 37: 291-299. 10.1080/16501970510034422.CrossRefPubMed
8.
go back to reference Ljungquist T, Arrelöv B, Lindholm C, Wilteus AL, Nilsson GH, Alexanderson K: Physicians who experience sickness certification as a work environmental problem: where do they work and what specific problems do they have? A nationwide survey in Sweden. BMJ Open. 2012, 2 (2): e000704-10.1136/bmjopen-2011-000704.CrossRefPubMedPubMedCentral Ljungquist T, Arrelöv B, Lindholm C, Wilteus AL, Nilsson GH, Alexanderson K: Physicians who experience sickness certification as a work environmental problem: where do they work and what specific problems do they have? A nationwide survey in Sweden. BMJ Open. 2012, 2 (2): e000704-10.1136/bmjopen-2011-000704.CrossRefPubMedPubMedCentral
9.
go back to reference Söderberg E, Alexanderson K: Sickness certificates as a basis for decisions regarding entitlement to sickness insurance benefits. Scandinavian Journal of Public Health. 2005, 33: 314-320. 10.1080/14034940510005798.CrossRefPubMed Söderberg E, Alexanderson K: Sickness certificates as a basis for decisions regarding entitlement to sickness insurance benefits. Scandinavian Journal of Public Health. 2005, 33: 314-320. 10.1080/14034940510005798.CrossRefPubMed
10.
go back to reference Lindholm C, Arrelöv B, Nilsson G, Löfgren A, Hinas E, Skåner Y, Ekmer A, Alexanderson K: Sickness-certification practice in different clinical settings; a survey of all physicians in a country. BMC Public Health. 2010, 10: 752-10.1186/1471-2458-10-752.CrossRefPubMedPubMedCentral Lindholm C, Arrelöv B, Nilsson G, Löfgren A, Hinas E, Skåner Y, Ekmer A, Alexanderson K: Sickness-certification practice in different clinical settings; a survey of all physicians in a country. BMC Public Health. 2010, 10: 752-10.1186/1471-2458-10-752.CrossRefPubMedPubMedCentral
11.
go back to reference Wahlström R, Alexanderson K: Swedish Council on Technology Assessment in Health Care (SBU). Chapter 11. Physicians' sick-listing practices (review). Scand J Public Health Suppl. 2004, 63: 222-255.CrossRefPubMed Wahlström R, Alexanderson K: Swedish Council on Technology Assessment in Health Care (SBU). Chapter 11. Physicians' sick-listing practices (review). Scand J Public Health Suppl. 2004, 63: 222-255.CrossRefPubMed
12.
go back to reference Alexanderson K, Norlund A, Eds: Sickness absence - causes, consequences, and physicians' sickness certification practice. A systematic literature review by the Swedish Council on Technology Assessment in Health Care. Scandinavian Journal of Public Health. 2004, 32 (Supplement 63): 1-263. Alexanderson K, Norlund A, Eds: Sickness absence - causes, consequences, and physicians' sickness certification practice. A systematic literature review by the Swedish Council on Technology Assessment in Health Care. Scandinavian Journal of Public Health. 2004, 32 (Supplement 63): 1-263.
13.
go back to reference Löfgren A, Arrelöv B, Hagberg J, 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): 178-185. 10.1080/02813430701430854.CrossRefPubMedPubMedCentral Löfgren A, Arrelöv B, Hagberg J, 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): 178-185. 10.1080/02813430701430854.CrossRefPubMedPubMedCentral
14.
go back to reference Löfgren A, Silén C, Alexanderson K: How physicians have learned to handle sickness-certification cases. Scandinavian Journal of Public Health. 2010, Accepted Löfgren A, Silén C, Alexanderson K: How physicians have learned to handle sickness-certification cases. Scandinavian Journal of Public Health. 2010, Accepted
15.
go back to reference Englund L, Tibblin G, Svärsudd K: Variations in sick-listing practice among male and female physicians of different specialites based on case vignettes. Scand J Prim Health Care. 2000, 1: 48-52. Englund L, Tibblin G, Svärsudd K: Variations in sick-listing practice among male and female physicians of different specialites based on case vignettes. Scand J Prim Health Care. 2000, 1: 48-52.
16.
go back to reference Wynne-Jones G, Mallen C, Main C, Dunn K: What do GPs feel about sickness certification? A systematic search and narrative review. Scand J Prim Health Care. 2010, 28: 67-75. 10.3109/02813431003696189.CrossRefPubMedPubMedCentral Wynne-Jones G, Mallen C, Main C, Dunn K: What do GPs feel about sickness certification? A systematic search and narrative review. Scand J Prim Health Care. 2010, 28: 67-75. 10.3109/02813431003696189.CrossRefPubMedPubMedCentral
17.
go back to reference von Knorring M, Sundberg L, Löfgren 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): 22-28. 10.1080/02813430701747695.CrossRefPubMedPubMedCentral von Knorring M, Sundberg L, Löfgren 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): 22-28. 10.1080/02813430701747695.CrossRefPubMedPubMedCentral
18.
go back to reference 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 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
19.
go back to reference Scheel IB, Hagen KB, Oxman AD: Active sick leave for patients with back pain: all the players onside, but still no action. Spine. 2002, 27 (6): 654-659. 10.1097/00007632-200203150-00016.CrossRefPubMed Scheel IB, Hagen KB, Oxman AD: Active sick leave for patients with back pain: all the players onside, but still no action. Spine. 2002, 27 (6): 654-659. 10.1097/00007632-200203150-00016.CrossRefPubMed
20.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
21.
go back to reference Campbell A, Ogden J: Why do doctors issue sick notes? An experimental questionnaire study in primary care. Fam Pract. 2006, 23 (1): 125-130.CrossRefPubMed Campbell A, Ogden J: Why do doctors issue sick notes? An experimental questionnaire study in primary care. Fam Pract. 2006, 23 (1): 125-130.CrossRefPubMed
22.
go back to reference 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 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
23.
go back to reference Engblom M, Alexanderson K, Rudebeck CE: Characteristics of sick-listing cases that physicians consider problematic–analyses of written case reports. Scand J Prim Health Care. 2009, 27 (4): 250-255. 10.3109/02813430903286286.CrossRefPubMedPubMedCentral Engblom M, Alexanderson K, Rudebeck CE: Characteristics of sick-listing cases that physicians consider problematic–analyses of written case reports. Scand J Prim Health Care. 2009, 27 (4): 250-255. 10.3109/02813430903286286.CrossRefPubMedPubMedCentral
24.
go back to reference 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 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
25.
go back to reference Watson PJ, Bowey J, Purcell-Jones G, Gales T: General practitioner sickness absence certification for low back pain is not directly associated with beliefs about back pain. Eur J Pain. 2008, 12 (3): 314-320. 10.1016/j.ejpain.2007.06.002.CrossRefPubMed Watson PJ, Bowey J, Purcell-Jones G, Gales T: General practitioner sickness absence certification for low back pain is not directly associated with beliefs about back pain. Eur J Pain. 2008, 12 (3): 314-320. 10.1016/j.ejpain.2007.06.002.CrossRefPubMed
Metadata
Title
Psychiatrists′ work with sickness certification: frequency, experiences and severity of the certification tasks in a national survey in Sweden
Authors
Gunnar H Nilsson
Britt Arrelöv
Christina Lindholm
Therese Ljungquist
Linnea Kjeldgård
Kristina Alexanderson
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2012
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-12-362

Other articles of this Issue 1/2012

BMC Health Services Research 1/2012 Go to the issue