Sickness certification in primary care: a survey on views and practices among Swiss physicians

S Kedzia,A Zeller,K Alexanderson,Boer De,P Frey,R Kunz,T Rosemann,L Herzig,J Sommer

doi:10.4414/smw.2015.14201

Abstract

Studies from several countries (Scandinavia, United Kingdom) report that general practitioners (GPs) experience problems in sickness certification. Our study explored views of Swiss GPs towards sickness certification, their practice and experience, professional skills and problematic interactions with patients. We conducted an online survey among GPs throughout Switzerland, exploring behaviour of physicians, patients and employers with regard to sickness certification; GPs' views about sickness certification; required competences for certifying sickness absence, and approaches to advance their competence. We piloted the questionnaire and disseminated it through the networks of the five Swiss academic institutes for primary care. We received 507 valid responses (response rate 50%). Only 43/507 GPs experienced sickness certification as problematic per se, yet 155/507 experienced problems in sickness certification at least once a week. The 507 GPs identified estimating a long-term prognosis about work capacity (64%), handling conflicts with patients (54%), and determining the reduction of work capacity (42%) as problematic. Over 75% would welcome special training opportunities, e.g., on sickness certifications during residency (93%), in insurance medicine (81%), and conflict management (80%). Sickness certification as such does not present a major problem to Swiss GPs, which contrasts with the experience in Scandinavian countries and in the UK. Swiss GPs did identify specific tasks of sickness certification as problematic. Training opportunities on sick-leave certification and insurance medicine in general were welcomed.

Highlights

In many countries, certification of sickness absence is typically performed by general practitioners (GPs)
Over 75% would welcome special training opportunities, e.g., on sickness certifications during residency (93%), in insurance medicine (81%), and conflict management (80%). Sickness certification as such does not present a major problem to Swiss GPs, which contrasts with the experience in Scandinavian countries and in the UK
Problematic tasks From a list of 12 sickness certification tasks, the following tasks ranked as top problems: providing longterm prognosis about future work capacity (64%), handling disagreement with the patient on the need for sick leave (54%), assessing the patient’s reduction of work capacity (42%) and functional capacity in general (27%), or recommending optimal duration of sick leave (28%)

Summary

Introduction

Certification of sickness absence is typically performed by general practitioners (GPs). Physicians in other countries, mostly GPs, are known to find sickness certification a problematic task. Researchers suggest different types of solutions: changing the procedure of sickness certification in healthcare provision [16], adapting the role and influence of the employer [17], but most of all researchers suggest improving the knowledge and skills of the certifying physicians [7, 8]. One limitation of the present knowledge regarding GPs’ sickness certification practices is that the studies are predominantly from the Scandinavian countries and the United Kingdom. One study from Switzerland from 2007 [16]

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