title: Inside the fitness for work consultation: a qualitative study.
abstract: BACKGROUND
  Evidence now suggests that work is generally good for physical and mental health and well-being. Worklessness for whatever reason can lead to poorer physical and mental health. The role of the general practitioner (GP) in the management of fitness for work is pivotal.
  
  
  OBJECTIVE
  To understand the interaction between GP and patient in the fitness for work consultation. This study forms part of a larger research project to develop a learning programme for GPs around the fitness for work consultation based on behaviour change methodology.
  
  
  METHODS
  A qualitative study set in South Wales. Structured discussion groups with seven GPs. Two sessions each lasting 3 h were conducted to explore the GP and patient interaction around the fitness for work consultation. Multiple methods were used to enhance engagement. Thematic analysis was used to analyse the data.
  
  
  RESULTS
  Four major themes emerged from the meetings: role legitimacy, negotiation, managing the patient and managing the systems. Within these, subthemes emerged around role legitimacy. 'It's not my job', 'It's not what I trained for' and the 'shifting agenda' Negotiation was likened to 'A polite tug of war' and subthemes around decision making, managing the agenda and dealing with uncertainty emerged.
  
  
  CONCLUSIONS
  This study starts to unravel the complexity of the fitness for work consultation. It illustrates how GPs struggle with the 'importance' of their role and 'confidence' in managing the fitness for work consultation. It addresses the skillful negotiation that is required to manage the consultation effectively.
authors.affiliation: Centre for Psychosocial and Disability Research, School of Psychology, Cardiff University, 51a Park Place, Cardiff CF10 3AT, UK. cohenda@cf.ac.uk
authors.forename: D A
authors.initials: DA
authors.lastname: Cohen
authors.forename: M
authors.initials: M
authors.lastname: Aylward
authors.forename: S
authors.initials: S
authors.lastname: Rollnick
mesh_terms: D005194:Family Practice / Q000193:education / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D036301:Qualitative Research; D018582:Sick Leave; D014938:Work Capacity Evaluation