title: 'The sick note': a qualitative study of sickness certification in general practice in Ireland.
abstract: BACKGROUND
  Sickness certification is a common task undertaken by General Practitioners (GPs) in most developed countries. Research suggests that they find this task complex and difficult. Primary health care structures and sickness certification practices differ across Europe and little research explores GPs certifying practices in the Republic of Ireland.
  
  
  OBJECTIVE
  The aim of the study was to explore GPs' views on sickness certification, the strategies used to issue sickness certificates to patients and scope for improvement in the current system.
  
  
  METHODS
  A qualitative thematic approach used one to one in-depth interviews with 14 individual GPs, across 11 primary health care practices in Ireland. Analysis of the data was conducted using NVivo 8 qualitative software.
  
  
  RESULTS
  GPs can find their role as certifier problematic, and a source of conflict during the consultation process with patients. GPs were concerned with breaching patient confidentiality and in particular disclosing illness to employers. They reported feeling inadequate in dealing with some cases requesting sickness leave, including certification for adverse social circumstances. Sickness certification was often given in response to patient demand. GPs felt a need for better communication between themselves, employers and relevant government departments.
  
  
  CONCLUSIONS
  This study highlights the various complexities and challenges that GPs face when dealing with patients requiring sickness certification. Issues in assessment of fitness for work and problems within the social welfare structure were recurrent themes. The study highlights the opportunities to improve the system and how these might be achieved. Further research is now warranted in Ireland.
authors.affiliation: Centre for Occupational and Environmental Health Research, University of Manchester, Oxford Road, Manchester, UK. mfoley@wit.ie
authors.forename: Michelle
authors.initials: M
authors.lastname: Foley
authors.forename: Kevan
authors.initials: K
authors.lastname: Thorley
authors.forename: Margaret
authors.initials: M
authors.lastname: Denny
mesh_terms: D001291:Attitude of Health Personnel; D002568:Certification; D003142:Communication; D003219:Confidentiality; D003625:Data Collection; D005260:Female; D058006:General Practice / Q000379:methods*; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D007494:Ireland; D008297:Male; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods; D018582:Sick Leave; D014938:Work Capacity Evaluation