title: Considerations made by the general practitioner when dealing with sick-listing of patients suffering from subjective and composite health complaints.
abstract: OBJECTIVE
  To explore GPs' considerations in decision-making regarding sick-listing of patients suffering from SHC.
  
  
  METHODS
  Qualitative analysis of data from nine focus-group interviews.
  
  
  METHODS
  Three cities in different regions of Norway. Participants. A total of 48 GPs (31 men, 17 women; aged 32-65) participated. The GPs were recruited when invited to a course dealing with diagnostic practice and assessment of sickness certificates related to patients with composite SHCs.
  
  
  RESULTS
  Decisions on sick-listing patients with SHCs were regarded as a very challenging task. Trust in the patient's own story and self-judgement was deemed crucial, but many GPs missed hard evidence of illness and loss of function. Several factors that might influence decision-making were identified: the patients' ability to present their story to evoke sympathy, the GP's prior knowledge of the patient, and the GPs' own experience as a patient and their tendency to avoid conflicts. The approach to the task of sick-listing differed from patient-led cooperation to resistant confrontation.
  
  
  CONCLUSIONS
  Issuing sickness certification in patients with composite health complaints is considered challenging and burdensome. It is seen as mainly patient-driven, and the decisions vary according to GPs' attitudes, beliefs, and personalities. Guiding the GPs to a more focused awareness of the decision process should be considered.
authors.affiliation: Uni Health, Bergen, Norway.
authors.forename: Stein
authors.initials: S
authors.lastname: Nilsen
authors.forename: Erik Lønnmark
authors.initials: EL
authors.lastname: Werner
authors.forename: Silje
authors.initials: S
authors.lastname: Maeland
authors.forename: Hege Randi
authors.initials: HR
authors.lastname: Eriksen
authors.forename: Liv Heide
authors.initials: LH
authors.lastname: Magnussen
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D058006:General Practice; D058005:General Practitioners / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D010817:Physician-Patient Relations; D011320:Primary Health Care; D018582:Sick Leave; D011795:Surveys and Questionnaires; D014938:Work Capacity Evaluation
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