title: Physicians' assessments of work capacity in patients with severe subjective health complaints: a cross-sectional study on differences between five European countries.
abstract: A comparison of appraisals made by general practitioners (GPs) in France and occupational physicians (OPs) and insurance physicians (IPs) in the Netherlands with those made by Scandinavian GPs on work capacity in patients with severe subjective health complaints (SHCs).
  
  
  
  GPs in France and OPs/IPs in the Netherlands gathered to watch nine authentic video recordings from a Norwegian general practice.
  
  
  
  46 GPs in France and 93 OPs/IPs in the Netherlands were invited to a 1-day course on SHC.
  
  
  
  Recommendation of sick leave (full or partial) or no sick leave for each of the patients.
  
  
  
  Compared with Norwegian GPs, sick leave was less likely to be granted by Swedish GPs (OR 0.51, 95% CI 0.30 to 0.86) and by Dutch OPs/IPs (OR 0.53, 95% CI 0.37 to 0.78). The differences between Swedish and Norwegian GPs were maintained in the adjusted analyses (OR 0.43, 95% CI 0.23 to 0.79). This was also true for the differences between Dutch and Norwegian physicians (OR 0.55, 95% CI 0.36 to 0.86). Overall, compared with the GPs, the Dutch OPs/IPs were less likely to grant sick leave (OR 0.60, 95% CI 0.45 to 0.87).
  
  
  
  Swedish GPs and Dutch OPs/IPs were less likely to grant sick leave to patients with severe SHC compared with GPs from Norway, while GPs from Denmark and France were just as likely to grant sick leave as the Norwegian GPs. We suggest that these findings may be due to the guidelines on sick-listing and on patients with severe SHC which exist in Sweden and the Netherlands, respectively. Differences in the working conditions, relationships with patients and training of specialists in occupational medicine may also have affected the results. However, a pattern was observed in which of the patients the physicians in all countries thought should be sick-listed, suggesting that the physicians share tacit knowledge regarding sick leave decision-making in patients with severe SHC.
authors.affiliation: Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway Research Unit for General Practice, Uni Research Health, Bergen, Norway.
authors.forename: Erik L
authors.initials: EL
authors.lastname: Werner
authors.affiliation: Department of Public and Occupational Health, the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Uni Research Health, Bergen, Norway.
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Merkus
authors.affiliation: Uni Research Health, Bergen, Norway Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway.
authors.forename: Silje
authors.initials: S
authors.lastname: Mæland
authors.affiliation: Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France.
authors.forename: Maud
authors.initials: M
authors.lastname: Jourdain
authors.affiliation: Department of Public and Occupational Health, the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands.
authors.forename: Frederieke
authors.initials: F
authors.lastname: Schaafsma
authors.affiliation: Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France.
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Canevet
authors.affiliation: Department of Public and Occupational Health, the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands Department of Social Medical Affairs, UWV, Dutch Social Security Agency, Amsterdam, The Netherlands.
authors.forename: Kristel H N
authors.initials: KH
authors.lastname: Weerdesteijn
authors.affiliation: Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Rat
authors.affiliation: Department of Public and Occupational Health, the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands.
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Anema
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003657:Decision Making; D003718:Denmark; D059026:Diagnostic Self Evaluation; D005260:Female; D005602:France; D058006:General Practice; D058005:General Practitioners; D006801:Humans; D007341:Insurance; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009664:Norway; D054538:Occupational Health Physicians; D010820:Physicians; D010818:Practice Patterns, Physicians'; D012720:Severity of Illness Index; D018582:Sick Leave; D011795:Surveys and Questionnaires; D013548:Sweden; D014938:Work Capacity Evaluation
keywords: GENERAL MEDICINE (see Internal Medicine); HEALTH SERVICES ADMINISTRATION & MANAGEMENT; OCCUPATIONAL & INDUSTRIAL MEDICINE; PAIN MANAGEMENT; PRIMARY CARE; PUBLIC HEALTH