How primary health care physicians make sick listing decisions: the impact of medical factors and functioning.
BACKGROUND
The decision to issue sickness certification in Sweden for a patient should be based on the physician's assessment of the reduction of the patient's work capacity due to a disease or injury, not on psychosocial factors, in spite of the fact that they are known as risk factors for sickness absence. The aim of this study was to investigate the influence of medical factors and functioning on sick listing probability.


METHODS
Four hundred and seventy-four patient-physician consultations, where sick listing could be an option, in general practice in Orebro county, central Sweden, were documented using physician and patient questionnaires. Information sought was the physicians' assessments of causes and consequences of the patients' complaints, potential to recover, diagnoses and prescriptions on sick leave, and the patients' view of their family and work situation and functioning as well as data on the patients' former and present health situation. The outcome measure was whether or not a sickness certificate was issued. Multivariate analyses were performed.


RESULTS
Complaints entirely or mainly somatic as assessed by the physician decreased the risk of sick listing, and complaints resulting in severe limitation of occupational work capacity, as assessed by the patient as well as the physician, increased the risk of sick listing, as did appointments for locomotor complaints. The results for patients with infectious diseases or musculoskeletal diseases were partly similar to those for all diseases.


CONCLUSIONS
The strongest predictors for sickness certification were patient's and GP's assessment of reduced work capacity, with a striking concordance between physician and patient on this assessment. When patient's complaints were judged to be non-somatic the risk of sickness certification was enhanced.
Norrmén
Gunilla
G
Uppsala University, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology Section, S-75185 Uppsala, Sweden. gunilla.norrmen@orebroll.se
Svärdsudd
Kurt
K
Andersson
Dan K G
DK
D000041:Absenteeism; D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003657:Decision Making; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data*; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards / Q000639:trends; D012044:Regression Analysis; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D018434:Sickness Impact Profile; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013548:Sweden; D014938:Work Capacity Evaluation