title: Sickness certification in primary care: a survey on views and practices among Swiss physicians.
abstract: OBJECTIVE
  Studies from several countries (Scandinavia, United Kingdom) report that general practitioners (GPs) experience problems in sickness certification. Our study explored views of Swiss GPs towards sickness certification, their practice and experience, professional skills and problematic interactions with patients.
  
  
  METHODS
  We conducted an online survey among GPs throughout Switzerland, exploring behaviour of physicians, patients and employers with regard to sickness certification; GPs' views about sickness certification; required competences for certifying sickness absence, and approaches to advance their competence. We piloted the questionnaire and disseminated it through the networks of the five Swiss academic institutes for primary care.
  
  
  RESULTS
  We received 507 valid responses (response rate 50%). Only 43/507 GPs experienced sickness certification as problematic per se, yet 155/507 experienced problems in sickness certification at least once a week. The 507 GPs identified estimating a long-term prognosis about work capacity (64%), handling conflicts with patients (54%), and determining the reduction of work capacity (42%) as problematic. Over 75% would welcome special training opportunities, e.g., on sickness certifications during residency (93%), in insurance medicine (81%), and conflict management (80%).
  
  
  CONCLUSIONS
  Sickness certification as such does not present a major problem to Swiss GPs, which contrasts with the experience in Scandinavian countries and in the UK. Swiss GPs did identify specific tasks of sickness certification as problematic. Training opportunities on sick-leave certification and insurance medicine in general were welcomed.
authors.affiliation: asim, Swiss Academy of Insurance Medicine, University Basel Hospital, University of Basel, Switzerland.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kedzia
authors.affiliation: asim, Swiss Academy of Insurance Medicine, University Basel Hospital, University of Basel, Switzerland.
authors.forename: Regina
authors.initials: R
authors.lastname: Kunz
authors.affiliation: Centre for Primary Health Care, University of Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zeller
authors.affiliation: Institute of General Practice and Health Services Research, University of Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.affiliation: Institute of General Practice, University of Bern, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Frey
authors.affiliation: Unité de Recherche et d'Enseignement en Médecine de Premier Recours, Université de Genève, Switzerland.
authors.forename: Johanna
authors.initials: J
authors.lastname: Sommer
authors.affiliation: Institut universitaire de médecine générale de Lausanne, Université de Lausanne, Switzerland.
authors.forename: Lilli
authors.initials: L
authors.lastname: Herzig
authors.affiliation: Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Alexanderson
authors.affiliation: asim, Swiss Academy of Insurance Medicine, University Basel Hospital, University of Basel, Switzerland.
authors.forename: Wout E L
authors.initials: WE
authors.lastname: de Boer
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D018582:Sick Leave / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013557:Switzerland