General practitioners’ relationship to sickness certification

Figures & data

Table I.  List of items: Numbers refer to their sequence in the questionnaire.

5-point Likert-scale items (1 = completely disagree to 5 = completely agree)		Dimension
1.1	Control tasks have not been a problem for me in practice	Burden (inverted)
1.2	I have often doubted whether my decisions are consistent with the intent of the relevant regulations	Doubt
1.3	If I am in doubt, the patient's view most often determines what I write	Permissiveness
1.4	Having control tasks as a doctor often feels like a personal burden	Burden
1.5	The times I have been strict, patients have just gone to another doctor	Observed events
1.6	Having control tasks as a doctor has been meaningful medical work for me	Burden (inverted)
1.7	I have often experienced that patients withhold information that is important for my decision	(not in dimension)
3.1	It should be allowed to give patients sick leave based on social indications, for example due to a spouse's illness	Sociopolitical attitude
3.2	Because of special problems that unemployed patients have, doctors should give them sick leave more easily than others	(not in dimension)
3.3	The patient should be examined personally by the doctor when sick leave is extended	Medical task
3.4	Telephone consultations are almost always medically justifiable for filling out a sick leave form	Medical task (inverted)
3.5	The patient's request for sick leave should be the most important consideration when the doctor fills out a sick leave form	Permissiveness
3.6	Sick leave is an important treatment alternative	Medical task
3.7	Decisions about sick leave often give me the feeling of being in conflict with my role as a helper	Burden
3.8	The simplified functional evaluation is determined entirely on information from the patient	Permissiveness
3.9	Filling out sick leave forms is a medical task	Medical task
3.10	Other health personnel besides doctors should not be allowed to make decisions about sick leave	Medical task
3.11	If a patient with cancer is unable to work because of depression, anxiety or unrest, I prefer to use cancer as the diagnosis on the sick leave form	(not in dimension)
3.12	If I am in doubt about which diagnosis to write on a sick leave form, I let the patient decide this	Permissiveness
3.13	I am not knowledgeable enough about examining the musculoskeletal system to be able to make a correct diagnosis	Self-evaluation (inverted)
3.14	I am not good at handling people with mental or social problems	Self-evaluation (inverted)
3.15	Filling out sick leave forms is a moral task	Medical task (inverted)
3.16	Sick leave is a matter for the workplace and it is unnecessary to involve doctors	Medical task (inverted)
3.17	I am less strict in practice than I think I should be in relationship to sick leave	Self-evaluation (inverted)
2.4	Do you experience that filling out a sick leave form is a positive or a negative task? (1 = negative −5 = positive)	Burden (inverted)
2.5	Do you feel that filling out a sick leave form is a meaningful task? (1 = not meaningful −5 = meaningful)	Burden (inverted)
Frequencies (never, monthly, weekly, daily)
2.1	How often are you in doubt whether to grant sick leave?	Doubt
2.2	How often are you in doubt about how long to grant sick leave for?	Doubt
2.3	How often do you meet patients who do not want be granted sick leave, even if you recommend it?	Observed events

Table II.  Characteristics of groups A, B, C, and D

	Groups					All
	A (n = 38)	B (n = 37)	C (n = 98)	D (n = 135)		n = 308
	Mean (SD) Mean rank	Mean (SD) Mean rank	Mean (SD) Mean rank	Mean (SD) Mean rank	Kruskal–Wallis H (p-value)	Mean (SD)
Females (%)					1.85^1
	27.4	24.3	36.8	26.5	(0.67)	27.9
Age	50.21 (8.23)	45.08 (8.54)	46.72 (8.30)	47.67 (8.31)	7.02
	181.53	131.78	146.58	158.87	(0.07)	47.4 (8.4)
Hours of patient contact per week	30.61 (8.53)	31.48 (6.68)	30.86 (6.99)	29.88 (7.51)	1.54
	158.14	162.37	157.99	146.63	(0.67)	30.4 (7.4)
Number of sick leaves granted per week	18.71 (10.70)	22.84 (11.77)	18.38 (9.22)	19.88 (13.90)	4.78
	148.08	183.48	147.54	149.77	(0.19)	19.7 (12.1)
Job satisfaction	54.66 (7.56)	51.24 (8.30)	52.45 (9.62)	52.52 (8.69)	2.80
	172.32	138.05	153.43	154.77	(0.42)	52.6 (8.8)
Degree of paternalism	8.74 (4.01)	7.78 (3.35)	7.80 (3.87)	8.50 (3.60)	3.26	8.2
	167.34	147.15	143.48	160.90	(0.35)	(3.7)
Extroversion–introversion	7.34 (2.45)	5.68 (2.72)	7.09 (2.71)	6.78 (2.79)	8.44	6.8
	169.45	118.18	163.84	153.47	(0.04)	(2.8)
Neuroticism	2.29 (2.05)	4.00 (2.60)	3.03 (2.30)	2.91 (2.33)	9.45	3.0
	127.55	189.04	156.35	151.27	(0.02)	(2.4)

¹Chi-squared.

Figure 1.  Boxplots of scores for groups A, B, and C. Median, interquartile range, outliers, and range after excluding outliers. Higher scores mean more burden, better self-evaluation, more doubt, more permissive management, more clear that sickness certification is a medical task, more liberal sociopolitical attitude, and higher frequency of observed events.

Table III.  Responses in groups A, B, and C. Higher scores mean more perceived burden, better self-evaluation, more doubt, more permissive management, more clear that sickness certification is a medical task, more liberal sociopolitical attitude, and higher frequency of observed events.

	Groups			Discriminating ability (rank)
	A (n = 38)	B (n = 37)	C (n = 98)	A–B	A–C	B–C
Dimension	Median (25^th;75^th) Mean rank	Median (25^th;75^th) Mean rank	Median (25^th;75^th) Mean rank	(p-value^1) rank	(p-value^1) rank	(p-value^1) rank
Burden	2.33	3.83	3.00
	(2.00; 2.67)	(3.50; 4.08)	(2.63; 3.33)	4.33 (< 0.001)		3.76 (< 0.001)
	58.59	266.91	143.75	1	4	1
Self-evaluation	4.67	2.67	3.50			1.55
	(4.33;5.00)	(2.50; 3.67)	(3.00; 4.00)	3.42 (< 0.001)	3.15 (< 0.001)	(0.016)
	262.72	88.14	143.55	3	2	6
Doubt	2.00	3.33	3.00			1.83
	(1.67; 2.33)	(3.00; 3.67)	(2.33; 3.33)	3.28 (< 0.001)	2.70 (< 0.001)	(0.002)
	61.45	228.86	164.95	4	5	5
Permissiveness	2.00	3.00	2.50		1.90	2.01
	(1.50; 2.25)	(2.75; 3.50)	(2.00; 2.75)	3.18 (< 0.001)	(0.001)	(0.001)
	74.05	233.61	142.17	5	6	4
Medical task	4.29	2.86	3.71
	(3.96; 4.46)	(2.50; 3.14)	(3.43; 4.04)	3.87 (< 0.001)	2.25 (< 0.001)	3.16 (< 0.001)
	243.92	51.59	171.93	2	3	2
Sociopolitical attitude	4.50	4.00	2.00	0.41
	(4.00; 5.00)	(3.00; 5.00)	(1.00; 3.00)	(0.996)	3.27 (< 0.001)	2.95 (< 0.001)
	195.03	175.96	78.13	7	1	3
Observed events	3.00	3.00	3.00		1.17	0.71
	(2.88; 3.50)	(2.50; 3.00)	(2.00; 3.50)	0.85 (0.470)	(0.132)	(0.692)
	184.08	151.36	158.62	6	7	7

¹Kolmogorov–Smirnov test.