Sick-listed employees with severe medically unexplained physical symptoms: burden or routine for the occupational health physician? A cross sectional study.
BACKGROUND
The two primary objectives of this study were to the assess consultation load of occupational health physicians (OHPs), and their difficulties and needs with regard to their sickness certification tasks in sick-listed employees with severe medical unexplained physical symptoms (MUPS). Third objective was to determine which disease-, patient-, doctor- and practice-related factors are associated with the difficulties and needs of the OHPs.


METHODS
In this cross-sectional study, 43 participating OHPs from 5 group practices assessed 489 sick-listed employees with and without severe MUPS. The OHPs filled in a questionnaire about difficulties concerning sickness certification tasks, consultation time, their needs with regard to consultation with or referral to a psychiatrist or psychologist, and communication with GPs. The OHPs also completed a questionnaire about their personal characteristics.


RESULTS
OHPs only experienced task difficulties in employees with severe MUPS in relation to their communication with the treating physician. This only occured in cases in which the OHP attributed the physical symptoms to somatoform causes. If they attributed the physical symptoms to mental causes, the OHPs reported a need to consultate a psychiatrist about the diagnosis and treatment.


CONCLUSIONS
OHPs experience few difficulties with their sickness certification tasks and consultation load concerning employees with severe MUPS. However, they encounter problems if the diagnostic uncertainties of the treating physician interfere with the return to work process. OHPs have a need for psychiatric expertise whenever they are uncertain about the psychiatric causes of a delayed return to work process. We recommend further training programs for OHPs. They should also have more opportunity for consultation and referral to a psychiatrist, and their communication with treating physicians should be improved.
University Medical Center Groningen, Department of Health Sciences, University of Groningen, The Netherlands. rob.hoedeman@arboned.nl
Rob
R
Hoedeman
Boudien
B
Krol
Annette H
AH
Blankenstein
Petra C
PC
Koopmans
Johan W
JW
Groothoff
D000041:Absenteeism; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D016001:Confidence Intervals; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D020380:Needs Assessment; D009426:Netherlands; D016272:Occupational Health / Q000706:statistics & numerical data*; D054538:Occupational Health Physicians / Q000706:statistics & numerical data*; D016017:Odds Ratio; D010808:Physical Examination; D010817:Physician-Patient Relations; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D018582:Sick Leave / Q000706:statistics & numerical data*; D018434:Sickness Impact Profile; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires