Abstract
BackgroundThe 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.MethodsSemi-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.ResultsWe 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.ConclusionThe 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.
Highlights
The number of people on sick-leave started to increase in Sweden and several other European countries towards the end of the 20th century
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 General Practitioners (GPs)' work situation as well as their patients' well-being
Our findings could be used to develop a questionnaire to measure the distribution of different views in a wider population of GPs
Summary
The number of people on sick-leave started to increase in Sweden and several other European countries towards the end of the 20th century. The number of sickdays has slowly declined in Sweden, after peaking in April 2002, partly due to a simultaneous increase in disability pensions [4]. This high level of sick-leave, strains the national budget, and probably induces negative effects for the patients [5,6]. Physicians are gate-keepers in the sickness benefit system in Sweden, as well as in most other western European countries. They mediate between the patients' needs and demands and the formal rules [7]. The certifying physician has an "expert role" [1] to determine to which extent disease or injury is impairing the patients' ability to perform their work, while the case manager at the local social insurance office formally determines whether the patient is entitled to monetary sickness benefits
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