title: Irish GP attitudes towards sickness certification and the 'fit note'.
abstract: BACKGROUND
  Sickness certification poses significant challenges to most general practitioners (GPs). As an alternative form of certification, in 2010, the UK implemented the 'fit note', which focuses on returning to work after illness. It has been well received in the UK but little is known of non-UK GP attitudes towards the fit note.
  
  
  OBJECTIVE
  To evaluate the challenges Irish GPs experience with the current sickness certification system and their attitudes towards the fit note.
  
  
  METHODS
  A questionnaire assessing attitudes, practices and preferences regarding the fit note was developed, piloted and posted to a representative sample of Irish GPs selected by systematic sampling. Descriptive statistics, chi-square tests and binary logistic regression were used to analyse the results.
  
  
  RESULTS
  Of 305 GPs surveyed, 64% (196) completed the survey. Ninety per cent (177) of responders reported a lack of available rehabilitation services for patients on sick leave and 66% (124) reported adverse effects of sickness certification on therapeutic relationships with patients. Those who indicated a preference for introducing the fit note (53%; 104) were significantly more likely to endorse both an excessive focus on disability [odds ratio (OR) = 3.16] and lack of GP training (OR = 2.04) in the sickness certification process.
  
  
  CONCLUSIONS
  Difficulties associated with sickness certification are apparent at GP-patient, GP-employer and GP-health service levels. Addressing these will require intervention at each of these levels and may be facilitated by challenging the assumption that illness equates to disability.
authors.affiliation: School of Health Science, University College Dublin, Belfield, Dublin 4, Ireland, romaineking@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: King
authors.affiliation: School of Health Science, University College Dublin, Belfield, Dublin 4, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Murphy
authors.affiliation: School of Medicine, Royal College of Surgeons of Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Wyse
authors.affiliation: School of Health Science, University College Dublin, Belfield, Dublin 4, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: Roche
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002568:Certification; D005260:Female; D058005:General Practitioners; D019538:Health Care Surveys; D058015:Health Communication / Q000379:methods*; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009787:Occupational Medicine / Q000639:trends*; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D062707:Return to Work; D018582:Sick Leave / Q000706:statistics & numerical data; D014938:Work Capacity Evaluation
keywords: Fit note; fitness to work; general practice; occupational health; sick certification.