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Sick-listing as a Psychosocial Work Problem: A Survey of 3997 Swedish Physicians

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Abstract

Objectives: To quantify the extent of emotionally straining sick-listing problems among three categories of physicians and find associations with workplace characteristics. Methods: A questionnaire was answered by 3997 physicians (response rate: 71%). Results: A larger proportion of physicians at orthopaedic clinics and, in particular, at Primary Health Care Centres (PHCCs), experienced sick-listing problems, compared to physicians at other clinics. Ten percent of PHCC physicians felt threatened by patients, at least once per month, in relation to sickness certification or worried about getting reported to the disciplinary board. PHCC physicians found sick-listing more problematic compared to others (OR 4.9; 95% CI 4.1–6.0). Having a workplace policy on sick-listing was associated with a reduced risk of experiencing several problems (OR 0.5–0.6, P < 0.05). Conclusion: The extent and nature of sick-listing problems warrant further concerns, especially in PHCCs. The nature of perceived threats should be elucidated. Developing workplace policies on sick-listing should be encouraged.

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References

  1. Stone, D. A. (1979). Physicians as gatekeepers: Illness certification as a rationing device. Public Policy, 27, 227–254.

    PubMed  CAS  Google Scholar 

  2. McCue, J. D. (1982). The effects of stress on physicians and their medical practice. The New England Journal of Medicine, 306, 458–463.

    Article  PubMed  CAS  Google Scholar 

  3. Arnetz, B. B., Andreasson, S., Strandberg, M., Eneroth, P., & Kallner, A. (1988). Comparison between surgeons and general practitioners with respect to cardiovascular and psychosocial risk factors among physicians. Scandinavian Journal of Work, Environment & Health, 14, 118–124.

    CAS  Google Scholar 

  4. Hofoss, D., & Nord, E. (1997). Norske leger–velstaende og velansette, men ikke spesielt lykkelige [Norwegian physicians–affluent and reputed, but not particularly happy] (in Norewegian). Tidsskrift for den Norske laegeforening, 117, 3476–3481.

    PubMed  CAS  Google Scholar 

  5. Firth-Cozens, J. (1998). Individual and organizational predictors of depression in general practitioners. The British Journal of General Practice, 48, 1647–1651.

    PubMed  CAS  Google Scholar 

  6. McManus, I. C., Keeling, A., & Paice, E. (2004). Stress, burnout and doctors’ attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMC Medicine, 2, 29.

    Article  PubMed  CAS  Google Scholar 

  7. Ramirez, A. J., Graham, J., Richards, M. A., Cull, A., & Gregory, W. M. (1996). Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet, 347, 724–728.

    Article  PubMed  CAS  Google Scholar 

  8. Caplan, R. P. (1994). Stress, anxiety, and depression in hospital consultants, general practitioners, and senior health service managers. BMJ, 309, 1261–1263.

    PubMed  CAS  Google Scholar 

  9. Calnan, M., Wainwright, D., Forsythe, M., Wall, B., & Almond, S. (2001). Mental health and stress in the workplace: the case of general practice in the UK. Social Science & Medicine, 52, 499–507.

    Article  CAS  Google Scholar 

  10. Coomber, S., Todd, C., Park, G., Baxter, P., Firth-Cozens, J., & Shore, S. (2002). Stress in UK intensive care unit doctors. British Journal of Anaesthesia, 89, 873–881.

    Article  PubMed  CAS  Google Scholar 

  11. Wahlström, R., & Alexanderson, K. (2004). Physicians’ sick-listing practices In: K. Alexanderson & A. Nordlund (Eds.), Sickness absence—causes, consequences and physicians’ certification practice. A systematic literature review by Swedish Council on Technology Assessment in Health Care (SBU): Scand J Public Health; 32 (supplement 63). pp. 222–255.

  12. Hussey, S., Hoddinott, P., Wilson, P., Dowell, J., & Barbour, R. (2004). Sickness certification system in the United Kingdom: Qualitative study of views of general practitioners in Scotland. BMJ, 328, 88.

    Article  PubMed  Google Scholar 

  13. Engblom, M., Rudebeck, C. E., Englund, L., & Norrmen, G. (2005). “Inte doktorns bord”–ett vanligt dilemma i sjukskrivningskonsultationer. [“Not the doctor’s pigeon”–a common dilemma in sick-listing consultations] (in Swedish). Lakartidningen, 102, 3666–3674.

    PubMed  Google Scholar 

  14. Löfgren, A., Arrelöv. B., Hagberg. J., Ponzer. S., Söderberg. E., & Alexanderson. K. (2007). Frequensy and nature of problems associated with sickness certification task: A cross-sectional questionnaire study of 5,455 physicians. Scandinavian Journal of Primary Health Care, in press.

  15. Getz, L., Westin, S., & Paulsen, B. (1994). Behandler og sakkyndig—mellom barken og veden? Allmenpraktikerens arbeid med utforepension i en innstrammningstid [Physician and expert–a conflict situation? General practitioners’ work with disability pension errands in a time of restraint policy] (in Norwegian). Tidsskrift for den Norske Laegeforening, 114, 1435–1440.

    PubMed  CAS  Google Scholar 

  16. Timpka, T., Hensing, G., & Alexanderson, K. (1995). Dilemmas in sickness certification among Swedish physicians. European Journal of Public Health, 5, 215–219.

    Article  Google Scholar 

  17. Chew-Graham, C., & May, C. (1999). Chronic low back pain in general practice: The challenge of the consultation. Family Practice, 16, 46–49.

    Article  PubMed  CAS  Google Scholar 

  18. Alexanderson, K., & Norlund, A. (Eds.). (2004). Sickness absence—causes, consequences and physicians’ sickness certification practice. A systematic literature review by the Swedish Council on Technology Assessment in Health Care: Scand J Public Health 32 (supplement 63). pp. 1–264.

    Google Scholar 

  19. Alexanderson, K., Brommels, M., Ekenvall, L., Karlsryd, E., Löfgren, A., Sundberg, L., & Österberg, M. (2005). Problem inom hälso- och sjukvården kring handläggning av patienters sjukskrivning [Problems within healthcare regarding managing patients’ sick-listing] (in Swedish). Stockholm: Karolinska Institutet.

    Google Scholar 

  20. Holland-Elliot, K. (2004). What about the workers? London: The Royal Society of Medical Press.

    Google Scholar 

  21. Försäkringskassan. Sveriges officiella statistik [Swedens’ official statistics] (in Swedish). (2006) [cited 2006 January 11th]; Available from: http://statistik.forsakringskassan.se

  22. Englund, L., Tibblin, G., & Svärdsudd, K. (2000). Variations in sick-listing practice among male and female physicians of different specialities based on case vignettes. Scandinavian Journal of Primary Health Care, 18, 48–52.

    Article  PubMed  CAS  Google Scholar 

  23. Liebetrau, A. (1983). Measures of association. Newbury Park: Sage Publications.

    Google Scholar 

  24. Wayne, D. W. (1999). Biostatistics: Foundation for analysis in the health sciences (7th ed.). New York: John Wiley and sons, Inc p. 755.

    Google Scholar 

  25. McWhinney, I. R. (1998). Primary care: Core values in a changing world. BMJ, 316, 1807–1809.

    PubMed  CAS  Google Scholar 

  26. Violence to Staff In the Health Services. In: Health Services Advisory Committee HaSC, London, editor. (1987).

  27. Hobbs, F. D., & Keane, U. M. (1996). Aggression against doctors: a review. Journal of the Royal Society of Medicine, 89, 69–72.

    PubMed  CAS  Google Scholar 

  28. Ness, G. J., House, A., & Ness, A. R. (2000). Aggression and violent behaviour in general practice: Population based survey in the north of England. BMJ, 320, 1447–1448.

    Article  PubMed  CAS  Google Scholar 

  29. O’Connell, P., & Bury, G. (1997). Assaults against general practitioners in Ireland. Family Medicine, 29, 340–343.

    PubMed  CAS  Google Scholar 

  30. Stewart, D. E., Ahmad, F., Cheung, A. M., Bergman, B., & Dell, D. L. (2000). Women physicians and stress. Journal of Women's Health & Gender-Based Medicine, 9, 185–190.

    Article  CAS  Google Scholar 

  31. Schattner, P. L., & Coman, G. J. (1998). The stress of metropolitan general practice. The Medical Journal of Australia, 169, 133–137.

    PubMed  CAS  Google Scholar 

  32. Richardsen, A. M., & Burke, R. J. (1993). Occupational stress and work satisfaction among Canadian women physicians. Psychological Reports, 72, 811–821.

    PubMed  CAS  Google Scholar 

  33. Brage, S., & Reiso, H. (1999). Arbeitsevne og kjønn - legers vurderinger av sykmeldte [Work ability and gender–physicians’ assessment of sick-listed patients] (in Norwegian). Tidsskrift for den Norske Laegeforening, 119, 3737–3740.

    PubMed  CAS  Google Scholar 

  34. Karlsryd, E. (1997). Det nya särskilda läkarintyget fr o m den 29:e dagen [The new special sickness certificate from day 29] (in Swedish). Socialmedicinsk Tidskrift, 8–9, 426–429.

    Google Scholar 

  35. Norrmen, G., Svardsudd, K., & Andersson, D. (2006). Impact of physician-related factors on sickness certification in primary health care. Scandinavian Journal of Primary Health Care, 24, 104–109.

    Article  PubMed  Google Scholar 

  36. Burck, R., Anderson-Shaw, L., Sheldon, M., & Egan, E. A. (2006). The clinical response to brain death: a policy proposal. JONA'S Healthcare Law, Ethics and Regulation, 8, 53–59.

    Article  PubMed  Google Scholar 

  37. Mann, C. J. (2003). Observational research methods. Research design II: cohort, cross sectional, and case-control studies. Emergency Medicine Journal, 20, 54–60.

    Article  PubMed  CAS  Google Scholar 

  38. Merriam-Webster’s Medical Dictionary. Dictionary.com. Merriam-Webster, Inc [cited 2006 December 5]; Available from: http://dictionary.reference.com/browse/conflict.

  39. WordNet® 2.0 Dictionary.com Princeton University [cited 2006 December 5]; Available from: http://dictionary.reference.com/browse/conflict.

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Acknowledgements

Stefan Peterson for commenting on the manuscript. This study was financially supported by the County Councils in Stockholm, Östergötland, and Uppsala, the National Social Insurance Board and its regional offices in Östergötland and Stockholm, and the Swedish Council for Working Life and Social Research.

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Authors and Affiliations

  1. Department of Neurosciences, Rehabilitation Medicine, Uppsala University, Akademiska Hospital, Uppsala, 751 85, Sweden

    Malin S. Swartling

  2. Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden

    Malin S. Swartling & Rolf A. Wahlström

  3. Department of Clinical Neuroscience, Section of Personal Injury Prevention, Karolinska Institutet, Stockholm, Sweden

    Jan Hagberg & Kristina Alexanderson

  4. Division of International Health, Department of Public Health Sciences (IHCAR), Karolinska Institutet, Stockholm, Sweden

    Rolf A. Wahlström

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  1. Malin S. Swartling
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  4. Rolf A. Wahlström
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Correspondence to Malin S. Swartling.

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Swartling, M.S., Hagberg, J., Alexanderson, K. et al. Sick-listing as a Psychosocial Work Problem: A Survey of 3997 Swedish Physicians. J Occup Rehabil 17, 398–408 (2007). https://doi.org/10.1007/s10926-007-9090-3

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  • DOI: https://doi.org/10.1007/s10926-007-9090-3

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