“The sick note” – An exploratory study examining General Practitioner perspectives on sickness certification in the Republic of Ireland

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Abstract

The increase in certified sickness absence recorded in most European countries duringthe last decade is of increasing concern to public health agencies (1, 2). While sicknessabsence can promote rest and recovery from illness, it may also have negativeconsequences, including increased risks of inactivity and isolation, poorer quality oflife and increased uptake of health services (3-5). In the Republic of Ireland (ROI)sickness certification is part of General Practitioners’ (GPs’) contractual service to theDepartment of Social Protection (DSP). Sickness certificates are also issued topatients as evidence of illness for employment purposes. There is limited researchexploring GPs certifying practices in the Republic of Ireland. The aim of the thesiswas to explore perspectives on sickness certification in general practice in Ireland.The data collection consisted of three stages. Study 1 consisted of in depth individualinterviews with 14 GPs across 11 primary care practices in Ireland. Study 2 was basedon an on-line questionnaire survey using a number of vignettes with 62 GPs workingin primary healthcare. Finally, study 3 consisted of a focus group conducted witheight GPs in a large urban practice in Ireland. Qualitative analysis was conducted inNVivo eight using content and simple thematic analysis techniques. Quantitative datawas analysed by descriptive and inferential statistics using PASW version 18 statisticalsoftware.Combined results indicate that GPs can find their role as certifiers’ problematic and asource of conflict during the consultation process with patients. GPs concerns arewith breaching patient confidentiality and in particular disclosing illness to employers.They reported feeling inadequate in dealing with some cases requesting sickness leave,including certification for adverse social circumstances and they felt a need for bettercommunication between themselves, employers and relevant governmentdepartments. Willingness to issue a sickness cert may be influenced by the nature ofthe patient’s presenting problem. A psychological problem generated greater beliefthat patients were unfit for work, and GPs were more sympathetic and showed greatersatisfaction with the decision they had made to certify these patient in comparison topatients with a physical problem. Average sickness certification periods were longer incases of psychological nature (1-2 weeks) in comparison to the physical complaint (4-7days). Overall GPs displayed a negative feeling towards prescribing sickness leaveand there was a perception that sickness certificates were being used by employers as amanagement tool in controlling absenteeism. GPs also mentioned cultural factors inwork place absenteeism and lack of rehabilitative pathway as impacting on sicknesscertification practices in Ireland.Issuing a sickness certificate appears influenced by medical and non-medical factors.Potential exists for improving the system, but requires significant engagement withother stakeholders such as employers and social benefit agencies. Focus should beplaced on referral and rehabilitative pathways for patients to ensure appropriatecertification and early return to work.

Keyword(s)

General practice; Medical certificate; Occupational health; Sick note ; Sickness certification

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