caa a22 4500 397516851 CHVBK 20180308164621.0 cr unu---uuuuu 161202s1995 xx s 000 0 eng 10.1093/eurpub/5.3.215 doi (NATIONALLICENCE)oxford-10.1093/eurpub/5.3.215 Dilemmas in sickness certification among Swedish physicians [Elektronische Daten] [TOOMAS TIMPKA, GUNNEL HENSING, KRISTINA ALEXANDERSON] Despite a growing concern for matters related to sick-leave and its economical and human consequences, little Is still known of the practice of sickness certification. To remedy this, a study based on the critical incident technique was designed to explore dilemmas experienced by physicians when issuing sickness certificates. A questionnaire was distributed to 170 general practitioners (GPs), private physicians and psychiatrists in the Swedish county of Ostergotland asking about sickness certification dilemmas, the consequences of the dilemma and how the situation was resolved. Through a semi-qualitative analysis, 2 main types of dilemma were identified. Insurance-associated dilemmas were the most frequent and concerned the grading of work incapacity, the duration of a sick-leave period and the difficulties in interpreting the sickness insurance legislation. The focus on biomedical diagnosis in the sickness certificate was found to complicate the certification routines, since working capacity may be reduced even though a diagnosis has not been confirmed. The primary medical dilemmas consisted of difficulties related to encountered obstacles In the clinical management, e.g. in subjective medical history, diagnosis or patient compliance. It is concluded that the physicians' role in the insurance system makes it necessary to give the medical diagnosis a social interpretation. The development of standards for grading of work incapacity is needed as well as routines for closer cooperation between the different actors in the sickness insurance system. © European Journal of Public Health ORIGINAL ARTICLES nationallicence sickness certification nationallicence physicians nationallicence critical incident technique nationallicence sickness insurance system nationallicence TIMPKA TOOMAS Department of Community Medicine, Faculty of Health Sdences, Linkoping, Sweden aut HENSING GUNNEL Department of Community Medicine, Faculty of Health Sdences, Linkoping, Sweden aut ALEXANDERSON KRISTINA Department of Community Medicine, Faculty of Health Sdences, Linkoping, Sweden aut The European Journal of Public Health Oxford University Press 5/3(1995), 215-219 1101-1262 5:3<215 1995 5 eurpub https://doi.org/10.1093/eurpub/5.3.215 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1093/eurpub/5.3.215 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- TIMPKA TOOMAS Department of Community Medicine, Faculty of Health Sdences, Linkoping, Sweden aut NATIONALLICENCE 700 1- HENSING GUNNEL Department of Community Medicine, Faculty of Health Sdences, Linkoping, Sweden aut NATIONALLICENCE 700 1- ALEXANDERSON KRISTINA Department of Community Medicine, Faculty of Health Sdences, Linkoping, Sweden aut NATIONALLICENCE 773 0- The European Journal of Public Health Oxford University Press 5/3(1995), 215-219 1101-1262 5:3<215 1995 5 eurpub Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford