Sickness certification in general practice

Publisher Website
Google Scholar
Abstract
Objective: Although sickness certification is assumed to be a frequent and sometimes stressful task for general practitioners there is little research on this topic. This pilot study was designed to examine the frequency of sick notes in general practices and whether doctor or patient initiated the issuing of a sickness certificate. Methods: In 14 general practices (10 single-handed) all patients who were employed or entitled to sickness benefits (n=469) were surveyed by a structured questionnaire on two predetermined weekdays (64% responded). For each patient the doctor had to fill out an extra documentation sheet. Results: Forty percent of the patients contacting the doctor received a sickness certification (range 12.5 to 60% per practice). The rate was only 7 per cent higher on Monday than on Thursday. The rates of men (41%) and women (37%) who received a sick note were nearly the same. Also, only small differences could be detected with regard to patients' occupations. Patients presenting with musculoskeletal, cardiovascular, digestive or skin problems had the highest probability of being certified sick. If the question of sickness certification was raised during the consultation a sick note was provided with a probability of about 80%. In most instances the doctors initiated the sickness certification. In 40 cases (18.1%) the patients and in only three cases (1.4%) the doctor refused a sickness certification. Conclusion: The issue of sick leave certificates characterises about half of the contacts of the ‘population at risk’. The rate of sickness certificates issued was higher than reported in other studies as the rate was, correctly, calculated only for the subjects who were entitled to sickness benefits. The variation between practices may be due to differences in the morbidity pattern of the patients or differences in the way doctors handle this problem. In most cases sickness certification seems to be a matter of mutual agreement between the doctor and his or her patient.