Sick-leave decisions for patients with severe subjective health complaints presenting in primary care: A cross-sectional study in Norway, Sweden, and Denmark

Abstract

Objectives. The primary objective of this study was to explore whether general practitioners (GPs) in Norway, Sweden, and Denmark make similar or different decisions regarding sick leave for patients with severe subjective health complaints (SHC). The secondary objective was to investigate if patient diagnoses, the reasons attributed for patient complaints, and GP demographics could explain variations in sick leave decisions. Design. A cross-sectional study. Method. Video vignettes of GP consultations with nine different patients. Subjects. 126 GPs in Norway, Sweden, and Denmark. Setting. Primary care in Norway, Sweden, and Denmark. Main outcome measure. Sick leave decisions made by GPs. Results. “Psychological” diagnoses in Sweden were related to lower odds ratio (OR) of granting sick leave than in Norway (OR = 0.07; 95% CI = 0.01–0.83) Assessments of patient health, the risk of deterioration, and their ability to work predicted sick leave decisions. Specialists in general medicine grant significantly fewer sick leaves than non-specialists. Conclusion. Sick-leave decisions made by GPs in the three countries were relatively similar. However, Swedish GPs were more reluctant to grant sick leave for patients with “psychological” diagnoses. Assessments regarding health-related factors were more important than diagnoses in sick-leave decisions. Specialist training may be of importance for sick-leave decisions.

Key Words::

• Diagnosis
• family practice
• general practice
• medically unexplained symptoms
• Norway
• primary health care
• sick leave
• somatoform disorder

Acknowledgements

The authors would like to thank all the participating GPs, Univisjon for filming and producing the video vignettes, and Silje E. Reme and Nina Konglevoll for technical assistance. They would also like to thank Elin Arvidson for her valuable help with data collection in Sweden, and Martin Munk, Dorthe Würtz, and Carsten O. Henriksen for running the Continued Medical Education groups in Denmark.

Declaration of interest

The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.

This study was funded by the Research Council of Norway (Grant number 187885/H20).