Frequency and severity of problems that general practitioners experience regarding sickness certification

Figures & data

Figure 1. Proportions of GPs (n = 2516) who rated different aspects of sickness certification as being very or fairly problematic.

Figure 2. Proportions of GPs (n = 2516) who, for different reasons and at least once a month, issued sick notes for unnecessarily long periods.

Table I. Total response rate among physicians with a specialty in general practice (GP), working in Sweden, aged less than 65 years, and working in primary health care (PHC) and frequency of sickness certification cases, respectively.¹

	Study populationAll physicians in Sweden with a board speciality in general practice (GP) N					Frequency of sickness-certification cases among the responding GPs working in PHC^3
		Responders		<65 years of age, and working in a PHC^2		At least 6 times per week		1–5 times per week		A few times per month or year		Never or almost never
		n	%	n	% of resp.	n	%	n	%	n	%	n	%
All	6900	4133^2	59.9	2701^2	65.4	1142	42.7	1374	51.4	121	4.5	38	1.4
Sex
Women	2913	1820	62.5	1232	67.7	476	39.0	659	54.0	65	5.3	21	1.7
Men	3987	2313	58.0	1469	63.5	666	45.8	715	49.2	56	3.9	17	1.2
Age
32–54 year	3028	1664	55.0	1281	77.0	581	45.6	637	50.0	45	3.5	10	0.8
55–64 year	3365	2134	63.4	1420	66.5	561	40.0	737	52.6	76	5.4	28	2.0
65–92 year	507	3352	66.1

Notes: ¹The study group consisted of 2516 GPs who had such consultations at least once a week (figures given in bold).

²The difference between 4133 responding GPs and 2701 is due to the fact that 335 were above the age of 64 and that 1097 mainly worked in other typea of setting, e.g. occupational health service.

³Missing 26 (1.0%)

Table II. Proportions of GPs (n = 2516) who experienced various situations related to handling sickness certification of patients.

	At least once a week		About once a month or a few times per year		Never or almost never
How often in your clinical work do you…	%	(95% CI)	%	(95% CI)	%	(95% CI)
… find sickness certification cases to be problematic?	54.5	(52.6–56.5)	43.8	(41.9–45.8)	1.7	(1.1–2.2)
… encounter a patient who wants to be on sick leave for some reason other than work incapacity due to disease or injury?	25.9	(24.2–27.7)	67.5	(65.7–69.4)	6.5	(5.6–7.5)
… say no to a patient who asks for a sickness certificate?	13.9	(12.5–15.3)	82.3	(80.8–83.8)	3.8	(3.0–4.5)
… have a patient who, partly or completely, says no to a sick leave you suggest?	6.8	(5.8–7.8)	68.0	(66.2–69.9)	25.2	(23.4–26.9)
… issue a sickness certificate so that a patient will be eligible for higher benefit than unemployment or social security benefits?	0.5	(0.2–0.8)	8.9	(7.8–10.0)	90.6	(89.5–91.8)
… have conflicts with patients about sickness certification?	11.3	(10.0–12.5)	74.6	(72.9–76.3)	14.1	(12.8–15.5)
… worry that a patient will report you to the medical disciplinary board in connection with sickness certification?	1.7	(1.2–2.2)	15.6	(14.2–17.1)	82.7	(81.2–84.2)
… feel threatened by a patient in connection with sickness certification?	1.4	(0.9–1.8)	21.3	(19.7–22.9)	77.3	(75.7–79.0)
… worry that patients will go to another physician if you don't sickness certify?	0.9	(0.5–1.3)	10.0	(8.8–11.2)	89.0	(87.8–90.3)
… have patients saying they will change physician if you don't sickness certify?	0.8	(0.4–1.1)	24.5	(22.8–26.2)	74.7	(73.0–76.4)

Table III. Proportions of GPs (n = 2516) who, for different reasons and at least once a month, issued sick notes for unnecessarily long periods by gender and age groups.¹

How often do you certify unnecessarily long sick-leave periods due to…	Women (n = 1135)	Men (n = 1381)	32–54 years (n = 1218)	55–64 years (n = 1298)
… waiting times for investigation by health care services?	63.9	66.8*	66.7	64.3
… waiting times for treatment?	61.5	66.3*	63.5	64.7
… waiting times for investigation by the social insurance office (SIO)?	51.0	52.4	52.4	51.1
… lack of access to cognitive behavioural therapy?	34.0	29.1*	34.1	28.5*
… waiting times for investigation by the unemployment office?	31.6	30.0	30.0	31.5
… waiting for measures to be taken by an employer?	29.4	29.5	29.7	29.3
… lack of other adequate treatment and/or care provider?	28.6	25.9*	28.0	26.2
… lack of next visit times?	26.7	26.0	27.8	24.9
… that the patient does not follow recommendations for treatment and rehabilitation?	23.0	21.9	26.1	18.8*
… you want to avoid conflicts with the patient?	9.2	14.2*	13.5	10.4*
… it takes too long to explain alternatives to being on sick leave?	8.8	14.5*	11.8	12.1
… influence of other members of your healthcare team?	7.3	7.3	8.4	6.3*

Notes: ¹Significant differences are shown in bold. *p < 0.05.