title: Sickness certification of patients--a work environment problem among physicians?
abstract: BACKGROUND
  According to several studies, physicians find sickness certification of patients to be problematic, and some smaller studies suggest that this is a psychosocial work environment problem (WEP).
  
  
  OBJECTIVE
  To explore to what extent physicians experience sickness certification as a WEP and the associations of this with the type of clinic and other workplace factors.
  
  
  METHODS
  Analyses of data from a questionnaire sent to all physicians who were living and working in Sweden. The study group consisted of physicians aged <65 years who performed sickness certification tasks (SCTs). Prevalence rates (PR) and 95% confidence intervals (CI) of finding SCTs as a WEP in relation to background factors were calculated.
  
  
  RESULTS
  The response rate was 61%. The final study group consisted of 14 210 responders. Half of the physicians (50%) experienced SCTs as a WEP, and 11% found them as a WEP to a great extent. The proportion of physicians experiencing certification tasks as a WEP varied with the type of clinic and were highest in general practice (73%), orthopaedics (68%), rheumatology (67%), neurology (59%) and psychiatry (58%). Using internal medicine as a reference group, the PRs for finding SCTs as a WEP to a great extent were 4.05 (95% CI 3.23-5.09) in general practice, 2.67 (2.05-3.47) in psychiatry and 2.66 (2.04-3.47) in orthopaedics, after adjusting for educational level and frequency of sickness certification consultations. In ear, nose and throat clinics, the PR was 0.43 (0.21-0.88).
  
  
  CONCLUSIONS
  The findings underline the importance of measures to improve the work situation for physicians regarding sickness certification practices.
authors.affiliation: Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden. therese.ljungquist@ki.se
authors.forename: T
authors.initials: T
authors.lastname: Ljungquist
authors.forename: E
authors.initials: E
authors.lastname: Hinas
authors.forename: B
authors.initials: B
authors.lastname: Arrelöv
authors.forename: C
authors.initials: C
authors.lastname: Lindholm
authors.forename: A L
authors.initials: AL
authors.lastname: Wilteus
authors.forename: G H
authors.initials: GH
authors.lastname: Nilsson
authors.forename: K
authors.initials: K
authors.lastname: Alexanderson
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D002568:Certification; D004777:Environment; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D010820:Physicians / Q000523:psychology; D018582:Sick Leave; D013548:Sweden; D014937:Work / Q000523:psychology; D014938:Work Capacity Evaluation; D017132:Workplace / Q000523:psychology; D055815:Young Adult