Assessing fitness for work: GPs judgment making

Figures & data

Box 1. Showing the psychological vignette version.

Vignette (1–4) variable type psychological problem (PSY+)

Mr X is a 38-year-old office manager who has been with the company for the last five years. The company is a large multinational company specializing in pharmaceuticals. Mr Flynn supervises a team of ten administrators. The job involves accounts, personnel and general administrative work. There are occasional visits to sister plants, but mainly the job is office-based.

Variable type (+) = Mr X is married with three children. Mr X partner works as a nurse in the local hospital; this often involves her working at night, and at weekends.

Variable type (−) = Mr X is single

Your notes indicate that Mr Flynn is experiencing intermittent low mood and tearfulness over the past two years. This has resulted in Mr X taking occasional days off work. A month ago he came to you and reported that he had experienced persistently low mood and tearfulness. Mr X also indicated that he is having problems with concentration and sleeping. You gave Mr X a sickness certificate for two weeks and prescribed an antidepressant.

At the end of the certification period Mr X returned to work for a four week period, but is now back at the surgery and states that the symptoms have ‘gotten worse’ and he is now having anxiety attacks and feels he just cannot cope.

Variable type (+) = Mr X asks if you can provide another sickness certificate. He feels that an extended period of recovery will help to alleviate some of the symptoms.

Variable type (−) = Mr X states that he cannot really afford to take more time off from work.

Box 2. Showing the physical vignette version.

Vignette (5–8)—variable type physical problem (PHY+)

Mr X is 41 years old. He has been a machine operator for the past five years. It is a local company that provides components to the medical devices industry. The job involves machine set-up, machining and measuring of component parts. The job also requires some lifting, which is assisted using hoist equipment.

Variable type (+) = Mr X is married with three children. Mr X partner works as a nurse in the local hospital; this often involves her working at night and at weekends.

Variable type (−) = Mr X is single

Mr X records show that he is experiencing occasional lower back pain over the past three years, which has lead to the occasional day or two off from work. He has been treated with pain killers on these occasions and you also recommended that he takes regular exercise. Two weeks ago Mr X came to you experiencing a dull ache in his lower back, which he explains has gotten progressively worse over the previous four months. Mr X describes that he is very stiff first thing in the morning.

You provide Mr X with a sickness certificate for a period of one week. Mr Walsh went back to work for one week, but he is now back at the surgery complaining of pain when bending down and reaching forward.

Variable type (+) = Mr X asks if you can provide another sickness certificate. He feels that an extended period of recovery will help to alleviate some of the symptoms.

Variable type (−) = Mr X states that he cannot really afford to take more time off from work.

Table 1. Showing the main thematic categories and references made for each vignette version.

	PSY	PSY	PSY	PSY	PHY	PHY	PHY	PHY
Vignette version	+++	++−	+−+	+−−	+++	++−	+−+	+−−
Frequency (f)	n = 7	n = 9	n = 8	n = 7	n = 5	n = 7	n = 7	n = 12
Question 1
Information seeking related to thepatients social/family circumstances
Thematic category	(f)	(f)	(f)	(f)	(f)	(f)	(f)	(f)
Interpersonal stress	4	3	2	2	2	3	1	3
Support structure	5	7	6	3	0	6	1	3
(Spouse, family, childcare, friends)
Relationship health	4	6	5	1	2	1	1	2
Financial situation	1	3	1	5	1	2	3	2
Substance misuse	1	4	4	3	0	1	1	4
Family history of illness	0	1	1	3	1	0	1	0
Social Isolation/living conditions	0	0	5	2	0	0	1	4
Physical activity and other interests	0	3	4	1	1	0	0	4
Question 2
Information seeking in patient’s history related to the workplace
Thematic category	(f)	(f)	(f)	(f)	(f)	(f)	(f)	(f)
Work-related stress	1	2	3	2	1	0	0	0
Work load	1	5	5	3	0	2	0	1
Bullying at work	4	3	5	3	2	0	1	0
Inter staff relationships and employee supports	4	5	3	3	1	0	1	4
Working tasks	4	2	3	0	4	5	3	8
Working conditions	0	2	3	5	2	6	2	10
Job satisfaction	2	0	0	0	2	0	1	1
Job security	2	0	2	1	1	0	1	1
Question 3
Additional information required to assess severity of patient's condition
Thematic category	(f)	(f)	(f)	(f)	(f)	(f)	(f)	(f)
Suicidal ideation	1	6	4	6	0	0	0	0
Physical and psychological signs and symptoms (mood, sleep appetite changes)	3	5	6	3	2	4	3	9
Physical medical evidence (X-ray, MRI, etc.)	0	0	0	0	2	3	5	8
Consultants report	1	1	0	0	0	0	2	0
Family history	3	2	3	0	0	1	0	2
Medication history	2	1	0	0	0	2	1	2

Table 2. Socio-demographic data of participating GPs.

n = 62	Frequency (f)	% respondents
Age
25–30 years	1	1.6
31–40 years	23	37.1
41–50 years	17	27.4
Older than 50 years	21	33.9
Gender
Male	25	40.3
Female	37	59.7
Undergraduate medical training
Ireland	59	94.2
UK	2	3.2
Other EU	1	1.6
GP training
Ireland	51	82.2
UK	9	14.5
Other EU	1	1.6
USA	1	1.6
Postgraduate training in occupation medicine
Yes	3	4.8
No	59	95.2