title: Frequency and severity of problems that general practitioners experience regarding sickness certification.
abstract: OBJECTIVE
  Tasks involved in sickness certification constitute potential problems for physicians. The objective in this study was to obtain more detailed knowledge about the problems that general practitioners (GPs) experience in sickness certification cases, specifically regarding reasons for issuing unnecessarily long sick-leave periods.
  
  
  METHODS
  A cross-sectional national questionnaire study.
  
  
  METHODS
  Primary health care in Sweden.
  
  
  METHODS
  The 2516 general practitioners (GPs), below 65 years of age, who had consultations involving sickness certification every week. This makes it the by far largest such study worldwide. The response rate among GPs was 59.9%.
  
  
  RESULTS
  Once a week, half of the GPs (54.5%) found it problematic to handle sickness certification, and one-fourth (25.9%) had a patient who wanted to be sickness absent for some reason other than medical work incapacity. Issues rated as problematic by many GPs concerned assessing work capacity, prognosticating the duration of incapacity, handling situations in which the GP and the patient had different opinions on the need for sick leave, and managing the two roles as physician for the patient and medical expert in writing certificates for other authorities. Main reasons for certifying unnecessarily long sick-leave periods were long waiting times in health care and in other organizations, and younger and male GPs more often reported doing this to avoid conflicts with the patient.
  
  
  CONCLUSIONS
  A majority of the GPs found sickness certification problematic. Most problems were related to professional competence in insurance medicine. Better possibilities to develop, maintain, and practise such professionalism are warranted.
authors: Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. monika@engark.se
authors: Monika
authors: M
authors: Engblom
authors: Gunnar
authors: G
authors: Nilsson
authors: Britt
authors: B
authors: Arrelöv
authors: Anna
authors: A
authors: Löfgren
authors: Ylva
authors: Y
authors: Skånér
authors: Christina
authors: C
authors: Lindholm
authors: Elin
authors: E
authors: Hinas
authors: Kristina
authors: K
authors: Alexanderson
mesh_terms: D000328:Adult; D002568:Certification; D003430:Cross-Sectional Studies; D005260:Female; D058005:General Practitioners; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care; D018582:Sick Leave; D011795:Surveys and Questionnaires; D013548:Sweden; D014938:Work Capacity Evaluation