title: Patients' attitudes to sickness certification in general practice.
abstract: BACKGROUND
  In 2010, the sick note was replaced with the fit note, designed to enable return to work. Despite considerable research relating to general practitioners' (GPs') attitudes and practice towards the fit note, little is known regarding the patients' perspective.
  
  
  OBJECTIVE
  We sought to identify patients' attitudes to and feelings about the process of sickness certification.
  
  
  METHODS
  Patients who received fit notes were invited to participate in tape-recorded telephone interviews, which were conducted with a semi-structured approach. Participants described their reason for sickness absence and whether it had been related to work. They were then asked to provide a narrative regarding their experience of the fitness for work process and their feelings about their GP and employer's reaction to sickness absence.
  
  
  RESULTS
  Nine patients were interviewed. Four main themes emerged from analysis of the interviews: 'significant stigma', 'a GP who knows me', 'value of work' and 'emotional barriers'. Patients expressed preference for being seen by a familiar GP with a greater perceived understanding of the patient's attitude to sickness and work.
  
  
  CONCLUSIONS
  The four emergent themes of stigma, the value of work, a doctor who knows you and emotion suggest that further research should focus on the problems of stigma associated with sickness certification and patients' emotional response to asking for certification.
authors.affiliation: Peninsula School of Medicine and Dentistry, Plymouth, Devon PL6 8BU, UK.
authors.forename: R
authors.initials: R
authors.lastname: Rachman
authors.affiliation: South Devon Healthcare Trust, Torbay Hospital, Lowes Bridge, Torquay, Devon TQ2 7AA, UK.
authors.forename: D
authors.initials: D
authors.lastname: Bunce
authors.affiliation: Lostwithiel Medical Centre, Lostwithiel, Cornwall PL22 0EF, UK. kevanthorley@doctors.org.uk.
authors.forename: K
authors.initials: K
authors.lastname: Thorley
authors.affiliation: Lostwithiel Medical Centre, Lostwithiel, Cornwall PL22 0EF, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hendriksz
mesh_terms: D000328:Adult; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D018582:Sick Leave / Q000191:economics / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology; D014938:Work Capacity Evaluation
keywords: Occupational health; qualitative study; sickness absence; work.