Abstract
BackgroundMusculoskeletal complaints have a significant impact on work in terms of reduced productivity, sickness absence and long term incapacity for work. This study sought to explore GPs’ and physiotherapists’ perceptions of sickness certification in patients with musculoskeletal problems.MethodsEleven (11) GPs were sampled from an existing general practice survey, and six (6) physiotherapists were selected randomly using ‘snowball’ sampling techniques, through established contacts in local physiotherapy departments. Semi-structured qualitative interviews were conducted with respondents lasting up to 30 minutes. The interviews were audio recorded and transcribed verbatim, following which they were coded using N-Vivo qualitative software and analysed thematically using the constant comparative methodology, where themes were identified and contrasted between and within both groups of respondents.ResultsThree themes were identified from the analysis: 1) Approaches to evaluating patients’ work problems 2) Perceived ability to manage ‘work and pain’, and 3) Policies and penalties in the work-place. First, physiotherapists routinely asked patients about their job and work difficulties using a structured (protocol-driven) approach, whilst GPs rarely used such structured measures and were less likely to enquire about patients’ work situation. Second, return to work assessments revealed a tension between GPs’ gatekeeper and patient advocacy roles, often resolved in favour of patients’ concerns and needs. Some physiotherapists perceived that GPs’ decisions could be influenced by patients’ demand for a sick certificate and their close relationship with patients made them vulnerable to manipulation. Third, the workplace was considered to be a specific source of strain for patients acting as a barrier to work resumption, and over which GPs and physiotherapists could exercise only limited control.ConclusionWe conclude that healthcare professionals need to take account of patients’ work difficulties, their own perceived ability to offer effective guidance, and consider the ‘receptivity’ of employment contexts to patients’ work problems, in order to ensure a smooth transition back to work.
Highlights
Musculoskeletal complaints have a significant impact on work in terms of reduced productivity, sickness absence and long term incapacity for work
Of all musculoskeletal pains back pain is the most common and it has been estimated that 12.5% of all work absence in the UK is attributable to back pain [3]
Sampling GP participants The GPs were sampled from respondents to the Sickness Certification in General Practice (SCIP) study who consented to further contact [14]
Summary
Musculoskeletal complaints have a significant impact on work in terms of reduced productivity, sickness absence and long term incapacity for work. Musculoskeletal complaints have a significant impact on work in terms of reduced productivity, sickness absence and long-term incapacity for work [1]. Long-term work absence poses a serious risk to physical, mental and social well-being, while return to work can improve recovery for people with common health problems [2]. In the UK only medical doctors, typically GPs sanction absence from work and are responsible for making the decision as to whether a patient is fit to work [5]. Healthcare professionals continue to report that they experience difficulties in making sick listing decisions, in primary care [7], this is compounded when it is found that just one in ten GPs in England and two in ten GPs in Wales received training in health and work during 2011–2012 [8]
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