Sick Note Research Articles

Changes in sick notes associated with COVID-19 from 2020 to 2022: a cohort study in 24 million primary care patients in OpenSAFELY-TPP

ObjectivesLong-term sickness absence from employment has negative consequences for the economy and can lead to widened health inequalities. Sick notes (also called ‘fit notes’) are issued by general practitioners when...

What drives the 'sick note culture' in the UK?

What drives the 'sick note culture' in the UK?

Book Review: Sick Note: A History of the British Welfare State by Gareth Millward

Book Review: <i>Sick Note: A History of the British Welfare State</i> by Gareth Millward

Readiness of medical graduates to self-guided work in primary health care organizations

Aim. To study the opinion of senior medical students about their readiness for self-guided practice in primary health care organizations.Material and methods. In 2023, a continuous cross- sectional social study was conducted among 5th and 6th year students of the Northern State Medical University (Arkhangelsk), of which 137 were from pediatric faculty (5th year — 70, 6th year — 65), 266 — general medicine faculty (5th year — 140, 6th year — 126).Results. An insufficient level of readiness of medical graduates for self-guided practice in primary health care facilities was revealed. Only 19,0%, after passing the primary accreditation, aim to immediately work as a local pediatrician and a local general practitioner, while 44,2% are not ready to begin independent practical activity. The main work direction of a local physician is considered to be prevention by 67,2% and 28,6% of senior pediatric and general medicine students, respectively. More than 75% of graduates are ready to work independently in a medical information system, but 15,1% of respondents are not sure that they will be able to independently make an electronic sick note, while 41% — a referral for disability examination, and about a third of graduates — fill out a statistical electronic form.Conclusion. The study results confirm the need to strengthen the practice in the training of medical students and introduce a mentoring system in primary health care facilities.

Clinical characteristics and sick leave associated with infectious mononucleosis in a real-world setting in Germany.

Infectious mononucleosis (IM), mainly caused by the Epstein-Barr virus, can result in prolonged symptoms. The objective of this study was to look at the length of sick leave, diagnosis of IM, treatment and comorbidities in a real-world setting in Germany. This retrospective, cross-sectional study used electronic medical record data from office-based practices in Germany and included patients with an initial confirmed diagnosis of IM between the 1 January 1 2016 and December 31 2018. Patients of working age (18-65years) with statutory health insurance were included in order to look at the working population who would need a sick note for their employers in case of illness. Epstein-Barr virus was the most common cause of IM in this population of 1,596 patients with an average age of 32years. The majority of patients were women in all cohorts (~60%). Although CFS, myocarditis and thrombocytopenia were not recorded frequently around the index date, the occurrence did increase during the follow-up period. Around half of patients received antibiotics. About 62% of all patients were on sick leave for an average of 20 calendar days around the time of their IM diagnosis. Only 1% were still on sick leave after 6months. A small percentage of patients remained on continuous sick leave after 6months, suggesting that the long-term effect of IM on the ability to work was minor in our cohort. However, patients could still be experiencing symptoms that influence their quality of life.

Health condition at first fit note and number of fit notes: a longitudinal study of primary care records in south London

ObjectivesThe fit note replaced the sick note in the UK in 2010, with the aim of improving support for patients requiring sickness absence, yet there has been very little research...

Emergency physician attitudes towards illness verification (sick notes).

IntroductionEmergency physicians frequently provide care for patients who are experiencing viral illnesses and may be asked to provide verification of the patient's illness (a sick note) for time missed from work. Exclusion from work can be a powerful public health measure during epidemics; both legislation and physician advice contribute to patients’ decisions to recover at home.MethodsWe surveyed Canadian Association of Emergency Physicians members to determine what impacts sick notes have on patients and the system, the duration of time off work that physicians recommend, and what training and policies are in place to help providers. Descriptive statistics from the survey are reported.ResultsA total of 182 of 1524 physicians responded to the survey; 51.1% practice in Ontario. 76.4% of physicians write at least one sick note per day, with 4.2% writing 5 or more sick notes per day. Thirteen percentage of physicians charge for a sick note (mean cost $22.50). Patients advised to stay home for a median of 4 days with influenza and 2 days with gastroenteritis and upper respiratory tract infections. 82.8% of physicians believe that most of the time, patients can determine when to return to work. Advice varied widely between respondents. 61% of respondents were unfamiliar with sick leave legislation in their province and only 2% had received formal training about illness verification.ConclusionsProviding sick notes is a common practice of Canadian Emergency Physicians; return‐to‐work guidance is variable. Improved physician education about public health recommendations and provincial legislation may strengthen physician advice to patients.

Factors Influencing Postoperative Recovery and Time Off Work of Patients with Benign Indications for Surgery - Results of a Prospective Study.

Objectives The study aimed to answer a number of questions: Which medical, psychological and sociodemographic factors affect the recovery of women after gynecological surgery for benign indications? Does patientsʼ health-related quality of life improve after surgical intervention? How long are patients signed off work postoperatively? How do patients assess their own capacity to work? Method Study population: All women between the ages of 18 and 67 years who underwent gynecological surgery for benign indications at the Charité Campus Virchow Clinic over a 7-month period were consecutively enrolled in the study. Four standardized patient surveys (the first survey [T0] was carried out in hospital, T1 at 1 week, T2 at 6 weeks and T3 at 7 – 8 months after discharge by telephone interview) were carried out using evaluated questionnaires to record patientsʼ recovery (Recovery Index), quality of life (RAND-36), satisfaction, complications, sociodemographic information and time off work with a medical sick note. Relevant medical and demographic data were also collected. Statistical analysis was carried out using univariate statistical tests for descriptive analysis and complex multifactorial statistical procedures to record observations over time. Results A total of 182 patients were included in this study (participation rate: 70%). Relevant prior operations (p = 0.01), in-hospital (p = 0.004) and postoperative complications (p < 0.001), preoperative psychological wellbeing (p = 0.01), physical functioning (p = 0.005) and postoperative anxiety (p = 0,006) had a significant impact on recovery (Recovery Index) and changed significantly over time (p < 0.001). The invasiveness of the surgery or sociodemographic parameters (including migration background) had no significant effect. Health-related quality of life (measured with the RAND-36 questionnaire) also improved postoperatively. More invasive surgical interventions were associated with longer sick leave times and, to a certain extent, with a poorer evaluation of patientsʼ capacity to work. Conclusion Recovery after gynecological surgery is a multifactorial process. This survey of a patient population identified psychological and physical factors which influence recovery but did not find significant sociodemographic parameters affecting recovery. Irrespective of these findings, gynecological surgery for benign indications resulted in an improvement in health-related quality of life. Prospective studies need to investigate whether psychological interventions could reduce preoperative fear and thereby improve postoperative recovery.

CAEP Position Statement - Sick notes for minor illness.

Employer- and school-mandated verification of minor illness leads patients to use healthcare resources solely to obtain a "sick note." This puts unnecessary strain on the patient and the emergency department (ED), and threatens to spread communicable diseases in our community.

Działalność gospodarcza i kariera zawodowa a zaangażowanie w proces studiowania

Artykuł podejmuje próbę sprawdzenia wybranych cech przedsiębiorczych wśród studentów w odniesieniu do ich zaangażowania w proces studiowania oraz potencjalnego zaangażowania jako pracowników. Głównym celem jest zweryfikowanie, na ile badani posiadają chęci do prowadzenia własnej działalności gospodarczej, oraz jaka jest ich świadomość związana z prowadzeniem takiej działalności. Badania ankietowe przeprowadzono na 138 studentach Wydziału Politologii Uniwersytetu Pedagogicznego im. KEN w Krakowie. Studenci biorący udział w badaniu zadeklarowali duże zaangażowanie w zdobywanie wiedzy oraz wysoko ocenili swoją komunikatywność. Nieco gorzej wypadają ich zaangażowanie w realizację dodatkowych przedsięwzięć oraz zdolności przywódcze. Stosunkowo spora grupa respondentów miała problem z określeniem swojego zaangażowania w studia. Badani studenci nie wykazywali skłonności do długiego dnia pracy, 98% z nich uznało, że mogłoby pracować osiem lub mniej godzin dziennie. W przypadku choroby badani studenci wykazali się dość dużym poświęceniem, niemal połowa mogłaby dalej pracować, o ile choroba nie byłaby ciężka, natomiast 22% badanych uznało, że starałoby się pracować z domu. Niewielu badanych, bo 14%, uznało, że nie będzie pracować na zwolnieniu lekarskim. Pytania zawarte w ankiecie nie dotyczyły wprost posiadania cech przedsiębiorczych, jednak deklarowane postawy studentów można odnieść do ich predyspozycji przedsiębiorczych i gotowości do prowadzenia własnej działalności gospodarczej.

ПОВСЯКДЕННЕ ЖИТТЯ КИЇВСЬКИХ СТУДЕНТІВ ПОЧАТКУ XX СТ.

In this article, we have studied constituents that comprised everyday life of students of the Kyiv Commercial Institute before the start of the WWI. This topic has not received much attention from scientists, but it is nevertheless important, since it helps to "take a look" without redundant fervour at the real atmosphere of student life and that of the Kyiv populace in early 20th century on the whole, furthermore when it's provided by evidences of contemporaries of that time. The special attention is devoted to things that were not usual for everyday life such as theft incidents, foreign trips of students (despite bad material situation), red-tape when receiving documents, spreading of untruthful information by students about their peers, etc. In this paper, we explore such facets of everyday life as how students got married and what they did when they were sick. In particular, the current at that time procedure provided that a permission to get married could be obtained from a university's administration, where a student studied. The thing is that Offices of the Registrar in universities checked personal files of those who requested such a permission for any reasons to refuse them. If students were sick for a long time, they had to provide a sick note from their attending doctor or medical institution where they were being treated. The author also has found an unappealing aspect in every-day life of students namely the fact that sometimes they were cruel toward the staff of a university. Naturally, studying was a considerable part of every-day life of students. However, this part of every-day life of students having been studied a lot by other scientists, it has not been examined in this paper. We mentioned only several cases of obtaining a second education or transferring of a student from one university to another as well as the enrolment procedure. In respect of the last component we have found out a number of documents that requested protection during enrolment.

General practitioner consultation after a visit to the emergency department: an observational study.

Some studies have demonstrated an association between poor continuity of care, high likelihood of 'inappropriate' use of emergency departments (EDs) and avoidable hospitalization. However, we lack data concerning primary care use after an ED visit. Identify the determinants of a visit to the general practitioner (GP) after an ED visit.Methods. Observational study (single-centre cohort). One emergency department in Paris, France. All adult patients who presented at the ED and were discharged. We collected data by the use of a standardized questionnaire, patients' medical records and a telephonic follow-up. Descriptive analyses were performed to compare individuals with and without a GP. Then, for those with a GP, multivariate logistic regression was used to identify the determinants of the GP consultation. We included 243 patients (mean age 45 years [±19]); 211 (87%) reported having a GP. Among those who reported having a GP, 52% had consulted their GP after the ED visit. Not having a GP was associated with young age, not having complementary health insurance coverage, and being single. GP consultation was associated with increasing age [adjusted odds ratios (aOR) = 1.03], poor self-reported health status (aOR = 2.25), medical complaints versus traumatic injuries (aOR = 2.24) and prescription for sick note (aOR = 5.74). Not having a GP was associated with factors of social vulnerability such as not having complementary health insurance coverage. For patients with a GP, consultation in the month after an ED visit seems appropriate, because it was associated with poor health status and medical complaints.

Patients' attitudes to sickness certification in general practice.

In 2010, the sick note was replaced with the fit note, designed to enable return to work. Despite considerable research relating to general practitioners' (GPs') attitudes and practice towards the fit note, little is known regarding the patients' perspective. We sought to identify patients' attitudes to and feelings about the process of sickness certification. Patients who received fit notes were invited to participate in tape-recorded telephone interviews, which were conducted with a semi-structured approach. Participants described their reason for sickness absence and whether it had been related to work. They were then asked to provide a narrative regarding their experience of the fitness for work process and their feelings about their GP and employer's reaction to sickness absence. Nine patients were interviewed. Four main themes emerged from analysis of the interviews: 'significant stigma', 'a GP who knows me', 'value of work' and 'emotional barriers'. Patients expressed preference for being seen by a familiar GP with a greater perceived understanding of the patient's attitude to sickness and work. The four emergent themes of stigma, the value of work, a doctor who knows you and emotion suggest that further research should focus on the problems of stigma associated with sickness certification and patients' emotional response to asking for certification.

Has the fit note reduced general practice sickness certification rates?

In 2010, the fit note replaced the sick note to help focus on what people are capable of doing, rather than signing patients 'off sick'. To compare proportions of work-related ill-health issued with sickness certification pre- and post-fit note introduction and assess sickness absence trends. General practitioners (GPs) report data on work-related ill-health and sickness absence via The Health and Occupation Research network in General Practice. The proportion of cases issued with sickness certification 4 years before and 3 years after the fit note introduction were compared. Changes in certification incidence rate ratios were measured over time. Participating GPs reported 5517 cases of work-related ill-health. Pre-fit note introduction 50% of cases were certified sick. There was no change in the proportion of cases certified sick in the first year post-fit note, despite 13% of cases classified as 'maybe fit'. However, in the second year, the proportion of cases certified sick had reduced significantly (41%) and a larger proportion (19%) was advised on workplace adjustments. In the third year post-introduction, there was a slight rise in the proportion of cases certified sick; therefore, although there was a fall of 2% per annum in certification rates, this was not significant. In the first year post-fit note introduction, modifications to work were recommended for people who would previously have been declared fit. Trends analyses showed a slight decrease in the certification rate, possibly indicating GPs will become more practised in advising on workplace adjustments.

Factors associated with the length of fit note-certified sickness episodes in the UK

ObjectivesTo identify diagnostic, patient/employee, general practitioner (GP) and practice factors associated with length of certified sickness episodes.MethodsTwelve-month collection of fit note data at 68 general practices in eight regions of...

Employers' views on the fit note.

The fit note replaced the sick note in 2010. The statement of fitness for work (fit note) is expected to benefit the British economy by helping more people stay in work and prevent long-term sickness absence. Understanding and responding to employers' views on the fit note is key, in order for this goal to be achieved. To explore employers' views on the fit note. A qualitative study was undertaken and face-to-face interviews were conducted with participants representing employers from a variety of industries. There were 21 participants who were mainly human resources officers and line managers. Employers welcomed the introduction of the fit note and felt that it was an improvement on the sick note. The majority of employers felt the fit note had the potential to promote an earlier return to work, if used properly. The main problems reported were the completion of the fit notes and quality of advice received from general practitioners. Employers felt that the most helpful advice came from fit notes with information on the functional effects of the medical condition. Some employers found return to work decisions problematic. The fit note has the potential to promote an earlier return to work. In order for the fit note to achieve its aim, further understanding of the difficulties employers are having when making return to work decisions is important, in order to develop guidance to enable them to provide the practical support employees need to return to work sooner.

The social negotiation of fitness for work: tensions in doctor-patient relationships over medical certification of chronic pain.

The UK government is promoting the health benefits of work, in order to change doctors' and patients' behaviour and reduce sickness absence. The rationale is that many people 'off sick' would have better outcomes by staying at work; but reducing the costs of health care and benefits is also an imperative. Replacement of the 'sick note' with the 'fit note' and a national educational programme are intended to reduce sickness-certification rates, but how will these initiatives impact on doctor-patient relationships and the existing tension between the doctor as patient advocate and gate-keeper to services and benefits? This tension is particularly acute for problems like chronic pain where diagnosis, prognosis and work capacity can be unclear. We interviewed 13 doctors and 30 chronic pain patients about their experiences of negotiating medical certification for work absence and their views of the new policies. Our findings highlight the limitations of naïve rationalist approaches to judgements of work absence and fitness for work for people with chronic pain. Moral, socio-cultural and practical factors are invoked by doctors and patients to contest decisions, and although both groups support the fit note's focus on capacity, they doubt it will overcome tensions in the consultation. Doctors value tacit skills of persuasion and negotiation that can change how patients conceptualise their illness and respond to it. Policy-makers increasingly recognise the role of this tacit knowledge and we conclude that sick-listing can be improved by further developing these skills and acknowledging the structural context within which protagonists negotiate sick-listing.

AB1384 Inflammatory back pain in primary care – where are we now?

BackgroundPrevious studies in Ankylosing Spondylitis (AS) have reported delays in diagnosis (average 8-11 years delay). The recently published UK survey clearly shows inequalities in access to services in the UK1....

Work, Health and Wellbeing

Work, Health and Wellbeing

The oldest sick note

The oldest sick note