title: Work-related sickness absence negotiations: GPs' qualitative perspectives.
abstract: BACKGROUND
  GPs can find their role as issuers of sickness certification problematic, particularly in trying to maintain a balance between certifying absence and preserving the doctor-patient relationship. Little research has been published on consultations in which sickness absence has been certified.
  
  
  OBJECTIVE
  To explore negotiations between GPs and patients in sickness absence certification, including how occupational health training may affect this process.
  
  
  METHODS
  A qualitative study was undertaken with GPs trained in occupational health who also participate in a UK wide surveillance scheme studying work-related ill-health. Telephone interviews were conducted with 31 GPs who had reported cases with associated sickness absence.
  
  
  RESULTS
  Work-related sickness absence and patients' requests for a 'sick note' vary by diagnosis. Some GPs felt their role as patient advocate was of utmost importance, and issue certificates on a patient's request, whereas others offer more resistance through a greater understanding of issues surrounding work and health acquired through occupational health training. GPs felt that their training helped them to challenge beliefs about absence from work being beneficial to patients experiencing ill-health; they felt better equipped to consider patients' fitness for work, and issued fewer certificates as a result of this.
  
  
  CONCLUSIONS
  Complex issues surround GPs' role in the sickness-certification process, particularly when determining the patient's ability to work while maintaining a healthy doctor-patient relationship. This study demonstrates the potential impact of occupational health training for GPs, particularly in light of changes to the medical statement introduced in 2010.
authors.affiliation: Centre for Occupational & Environmental Health, University of Manchester, Manchester. annemarie.money@manchester.ac.uk
authors.forename: Annemarie
authors.initials: A
authors.lastname: Money
authors.forename: Louise
authors.initials: L
authors.lastname: Hussey
authors.forename: Kevan
authors.initials: K
authors.lastname: Thorley
authors.forename: Susan
authors.initials: S
authors.lastname: Turner
authors.forename: Raymond
authors.initials: R
authors.lastname: Agius
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002568:Certification; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018582:Sick Leave / Q000706:statistics & numerical data*; D006113:United Kingdom; D014938:Work Capacity Evaluation; D055815:Young Adult