Work capacity assessments – reviewing the what and how of physicians’ clinical practice

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Abstract Background Although a main task in the sickness certification process, physicians’ clinical practice when assessing work capacity has not been thoroughly described. Increased knowledge on the matter is needed to support a better and more reliable certification process. In this review, we aimed to synthesise existing evidence to provide a clearer description of the work capacity assessment as practiced by physicians. Methods Seven electronic databases were searched systematically for qualitative studies examining what and how physicians do when they assess work capacity. Data was analysed and synthesised using qualitative manifest content analysis. Results Twelve articles were included in the review. Results show that physicians seek to form a knowledge base including understanding the condition, the patient and the patient’s workplace. They consider both medical and non-medical aspects to affect work capacity. Accordingly, to acquire and process the information they use both medical and non-medical skills, methods and resources. Medical competence is an important basis, but not enough. Time, trust, intuition and reasoning are also used to assess the patient’s claims and to translate the findings into a final decision. The depth and focus of the information seeking and processing vary depending on several factors. Conclusions The work capacity assessment is a complex task where physicians rely on their non-medical skills to a higher degree than in ordinary clinical work. These skills are highly relevant but need to be complemented with methods to better understand the patient’s work place, as well as theoretical knowledge regarding the intricate associations between health, work and social security. This would further enhance physicians’ competence and confidence, and promote better experiences and practices of the work capacity assessment. Key messages In the complex task of assessing work capacity physicians rely on their non-medical skills to a higher degree than in ordinary clinical work. A better understanding of the patient’s work situation and the intricate associations between health, work and social security would enhance physicians’ competence and promote better assessments.