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  • Are there patient-related factors that influence sickness certification in patients with severe subjective health complaints? A cross-sectional exploratory study from different European countries

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Qualitative research
Research
Are there patient-related factors that influence sickness certification in patients with severe subjective health complaints? A cross-sectional exploratory study from different European countries
  1. Suzanne L Merkus1,2,3,
  2. Rob Hoedeman4,
  3. Silje Mæland1,5,
  4. Kristel H N Weerdesteijn2,3,6,
  5. Frederieke G Schaafsma2,3,6,
  6. Maud Jourdain7,
  7. Jean-Paul Canevet7,
  8. Cédric Rat7,
  9. Johannes R Anema2,3,6,
  10. Erik L Werner1,8
  1. 1 Research Unit for General Practice, Uni Research Health, Bergen, Norway
  2. 2 Department of Public and Occupational Health, VU University Medical Centre, Amsterdam, The Netherlands
  3. 3 EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
  4. 4 Department of Science, ArboNed Occupational Health Services, Utrecht, The Netherlands
  5. 5 Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
  6. 6 Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
  7. 7 Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
  8. 8 Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
  1. Correspondence to Suzanne L Merkus; slmerkus{at}gmail.com

Abstract

Objectives To develop hypotheses about whether there are patient-related factors that influence physicians’ decision-making that can explain why some patients with severe subjective health complaints (SHCs) are more likely to be granted sick leave than others.

Design Exploratory cross-sectional.

Setting Assessments of patient-related factors after watching nine authentic video recordings of patients with severe SHC from a Norwegian general practice. Our previous study showed that three of these nine patients were less likely than the remaining six patients to be granted sick leave by physicians from five European countries.

Participants In total, 10 assessors from Norway, the Netherlands and France.

Outcomes The direction in which the assessments may contribute towards the decision to grant a sickness certificate (increasing or decreasing the likelihood of granting sick leave).

Results Physicians consider a wide variety of patient-related factors when assessing sickness certification. The overall assessment of these factors may provide an indication of whether a patient is more likely or less likely to be granted sick leave. Additionally, some single questions (notable functional limitations in the consultation, visible suffering, a clear purpose for sick leave and psychiatric comorbidity) may indicate differences between the two patient groups.

Conclusions Next to the overall assessment, no notable effect of the complaints on functioning and suffering, a lack of a clear purpose for sick leave and the absence of psychiatric comorbidity may be factors that could help guide the decision to grant sick leave. These hypotheses should be tested and validated in representative samples of professionals involved in sickness certification. This may help to understand the tacit knowledge we believe physicians have when assessing work capacity of patients with severe SHC.

  • sick leave
  • subjective health complaints
  • tacit knowledge
  • decision making

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-015025

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    Footnotes

    • Contributors SLM conducted the literature search. SLM, ELW and RH developed the questions. SLM was responsible for the data analysis. All authors assessed the nine video vignettes, revised the manuscript critically for important intellectual content and approved the final version to be published.

    • Funding The study was funded by the Norwegian Labour and Welfare Administration through the FARVE program.

    • Competing interests None declared.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no other unpublished data available from this study.