Suitability of issuing sickness certifications in remote consultations during the COVID-19 pandemic. A mixed method study of GPs’ experiences

Abstract

Objective

To explore Norwegian GPs’ experiences with and perceived suitability of issuing sickness certifications in remote consultations during the COVID-19 pandemic.

Design

We used a mixed methods research design. An online survey with 301 respondents was combined with qualitative interviews with ten GPs.

Setting

Norwegian general practice.

Results

Most GPs agreed it was difficult to assess a patient’s ability to work without physical attendance for a first-time certification in remote consultations. However, extending a certification was considered less problematic. If physical examinations were required, the GPs would ask the patient to come to the office. The most suitable diagnoses for remote certification were respiratory infections and COVID-19-related diagnoses, as well as known chronic and long-term diseases. The GPs emphasized the importance of knowing both the patient and the medical problem. The GP-patient relationship could be affected by remote consultations, and there were mixed views on the impact. Many GPs found it easier to deny a request for a sickness certification in remote consultations. The GPs expressed concern about the societal costs and an increased number of certifications if remote consultations were too easily accessible. The study was conducted during the COVID-19 pandemic, and the findings should be interpreted in that context.

Conclusions

Our study shows that issuing sickness certifications in remote consultations were viewed to be suitable for COVID-19 related problems, for patients the GP has met before, for the follow-up of known medical problems, and the extension of sickness certifications. Not meeting the patient face-to-face may affect the GP-patient relationship as well as make the GPs’ dual role more challenging.

KEY POINTS

• The GPs perceived issuing sickness certifications in remote consultations as suitable when patient and health problem are known, and when the certification is an extension.

• Issuing sickness certifications in remote consultations can both harm and strengthen the GP-patient relationship.

• The GPs were aware of their social responsibility and were concerned that issuing sickness certificates in remote consultations can change their sick-listing practice.

Keywords:

• e-health
• remote consultation
• primary health care
• sickness certification
• qualitative research
• quantitative research

Acknowledgements

The authors thank all participants in the study and SKIL for facilitating the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The study was commissioned and funded by the Norwegian Ministry of Labour and Social Inclusion. The study was conducted as part of a project aimed to investigate GPs’ and patients’ experiences with sickness certifications by remote consultations during the COVID-19 pandemic, as well as the characteristics of these sickness certifications.