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

Figures & data

Table I. Demographic profile of the participating GPs in Norway, Sweden, and Denmark (n = 126) and between-countries differences (ANOVA).

	Norway n (%)	Sweden n (%)	Denmark n (%)	p-value
Female	20 (36)	16 (55)	27 (66)	0.01
Age:				0.09
≤ 40	15 (27)	5 (17)	5 (12)
41–50	21 (37)	6 (21)	19 (46)
≥ 51	20 (36)	17 (59)	17 (41)
GP experience (years)				0.01
≤ 10	21 (37)	10 (34)	22 (54)
11–15	12 (21)	4 (14)	9 (22)
≥ 16	23 (41)	14 (48)	10 (24)
Specialist in general medicine	36 (64)	26 (90)	40 (98)	< 0.01
No, or other medical speciality	5 (9)	11* (38)	–	< 0.01

Notes: P-values ≤ 0.05 were considered statistically significant. *These GPs were also specialists in general medicine. Norway n = 56, Sweden n = 29, Denmark n = 41.

Table II. Description of the patients presented in the video vignettes, gender, age, demography, complaints, and self-assessment of disability.

Vignette	Gender, age	Demography	First complaint mentioned in consultation/principal complaint	Secondary complaints	Self-assessment of disability
1	♀ 25	Single, no children Interrupted secondary education Currently in rehabilitation program Several short-time jobs and sick-leave spells	General pain in the neck, the back and in arms Intense pain 24 hours per day, 7 days a week	Respiratory complaints, no objective findings of asthma or other known somatic disease Anxiety and depression periodically treated with antidepressants	Expresses hope to achieve ability to work, but needs substantial improvement in health conditions first
2	♂ 40	Married, two children Working offshore on oil platform as a mechanic – two weeks on, four weeks off work Several shorter periods of sick leave and two long spells (one year each)	Back and neck pain	Sleep disturbances due to pain Irritable bowel syndrome, skin eczema	The work is physically hard and provokes pain He does not see himself in this job until retirement, but the salary and long periods off work make him keep the job
3	♀ 53	Housewife for 20 years with five foster-care children in addition to two biological children The fostering years have ended and her income consequently also Bringing up foster children has been challenging due to narcotics and psychiatric disorders in the foster children	Generalized, widespread non-specific pain	Anxiety, non-insulin dependent diabetes, general fatigue, no energy left	She has not had any working experiences outside home for nearly 30 years She feels exhausted and wants to be left alone with no demands of working activity or qualification for work
4	♂ 37	Married, unknown number of children. Previously working offshore, but started as self-employed in construction	General intense fatigue	No other complaints but has read about CFS which he finds fits his problems Economic burdens due to poor benefit coverage as self-employed	No work capacity
5	♂ 42	Married, three children Works as formwork carpenter No previous history of sick leave A 12-year-old daughter with serious behavioural problems, she refuses to go to school, meets her parents with substantial aggression, runs away from home. The girl is enrolled in a behavioural training program with great demands of parents’ involvement	He feels physically and psychologically exhausted, afraid that he might collapse No energy left to deal with his daughter after work	No other complaints.	He needs time off to deal with his family problems The program is set for 3–4 months
6	♀ 37	No information on marital status or children Working in a kindergarten Previous four-month sick leave for same complaints was followed by no symptoms for one and a half years	Periodic numbness, staring like a toothache, followed by headache and a sensation of anesthesia on the right side of the body; things slips out of her hand Extensive medical examination has not proved any cause for the symptoms	No other complaints	Difficult to work with these complaints, unsure about sick leave
7	♀ 35	No information on marital status or children Working as teacher in primary school No previous sick leave history, no previous psychiatric or somatic disorder	Feeling tired, weak, doesn't get things done, struggling, powerless, sleep disturbances Relates the symptoms to work overload	No other complaints	She feels she may need time out from work
8	♂ 36	Married, two small children Working as teacher at comprehensive level Very active sports trainer, coaches a 1st division handball team No previous sick leave history, no previous psychiatric or somatic disorder Worried about possible serious illness despite negative examinations so far An affair a year ago bothers him a lot	Pain started in the jaw muscle, following in the neck, head, and stomach	Sleep disturbances, frustrated, lack of energy, withdrawal from social events and friends, anxious	He wants to return to work but not for the moment
9	♂ 38	Married, no children Works as a technician in an events bureau, producing big shows, theatres, films As the work is located in another city 270 km away he commutes weekly	General tiredness from work and commuting, low energy According to his wife, he is irritable and passive, even aggressive towards his wife	No other complaints	The wife makes the doctor's appointment as he himself has left work three weeks ago and made no contact with his employer

Figure 1. Percentage of GPs in each country granting sick leave to patients 1–9.

Table III. Adjusted ORs, using mixed-effects logistic regression analysis, of the probability that the GPs in each country will grant the patients sick leave or not.^1.

	Norway		Sweden		Denmark
	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value
GP characteristics: Female	1.43 (0.46–4.41)	0.536	1.36 (0.30–6.29)	0.690	0.84 (0.25–2.81)	0.774
Male (ref)	1	–	1	–	1	–
Age Years practicing as a GP Specialist in general medicine	1.01 (0.34–2.98) 1.26 (0.71–2.22) 0.24 (0.06–0.93)	0.985 0.432 0.039	0.87 (0.27–2.74) 1.27 (0.71–2.28) –*	0.809 0.428 –	0.94 (0.31–2.84) 1.24 (0.62–2.46) –*	0.907 0.538 –
No, or other medical specialty (ref) GP's assessment:	1	–	–*	–	–*	–
General and unspecified (A)	7.06 (1.40–35.72)	0.018	–*	–	1.48 (0.30–7.26)	0.629
Psychological (P)	9.94 (2.37–41.78)	0.002	0.33 (0.07–1.61)	0.170	1.52 (0.37–6.19)	0.562
Musculoskeletal (L)	3.20 (0.72–14.33)	0.128	1.63 (0.21–12.77)	0.641	0.41 (0.06–2.80)	0.366
Other organ chapters (ref)	1	–	1	–	1	–
Work situation is the main reason for the patient's complaints	0.90 (0.63–1.30)	0.589	1.23 (0.71–2.12)	0.456	1.46 (0.97–2.19)	0.071
His/her private life is the main reason for the patient's complaints	1.04 (0.65–1.67)	0.870	0.62 (0.30–1.29)	0.200	0.91 (0.58–1.42)	0.674
Medical and health-related factors are the main reason for granting sick leave	0.56 (0.36–0.88)	0.011	0.44 (0.21–0.94)	0.033	0.93 (0.61–1.43)	0.753
The patient is not motivated for work	0.84 (0.56–1.26)	0.407	1.49 (0.85–2.62)	0.161	1.18 (0.80–1.73)	0.408
If this patient is not sick-listed the complaints may worsen or slow down healing	0.29 (0.18–0.46)	< 0.001	0.39 (0.21–0.72)	0.002	0.24 (0.15–0.39)	< 0.001
The patient has reduced work ability	0.30 (0.19–0.46)	< 0.001	0.15 (0.07–0.33)	< 0.000	0.36 (0.21–0.64)	< 0.001
Normal work ability (ref)	1	–	1	–	1	–

Notes: ¹The model includes characteristics of the GP, the GP's assessment of diagnosis of the patient, and the GP's evaluation of the patient's ability to work, and if work will have a negative effect on the patient's health, and the GP's evaluation of factors that can explain the patient's complaints or need for sick leave. P-values ≤ 0.05 were considered statistically significant. *No estimate due to sparse data or no observations.