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Lack of important content in sickness certificates


About half of the medical certificates for sick leave are deficient, according to research at Sahlgrenska Academy. Quality of the certificates was poorest in the case of symptom diagnosis, where the sickness itself had not been identified.

“The shortcomings primarily concerned descriptions of why a person cannot work – for example, because of panic attacks when encountering customers, or inability to stand and operate machines as usual,” says Karin Starzmann, PhD student in general medicine specializing in physicians sick-leave practices and views on sick leaves.

The Swedish sickness certificate is on four side and has to be very well formulated. In a section of her dissertation, she has studied the quality of 444 medical certificates for sick leave from 20 medical centers in Skaraborg. Karin Starzmann is a General Practitioner (GP) in the area herself and also works with sick leaves in general.

The results were really bad in the case of symptom diagnoses, when patients have symptoms, but a diagnosis of the sickness is lacking. 56 percent of these certificates were incomplete. The percentage of certificates lacking specific diagnoses of sicknesses was 44 per cent.

Difficult challenge

“Symptom diagnoses are predictive of lower quality in the certificates and the sick leave process, but I can’t say the results were particularly good in the second set either. Both groups lacked essential content,” Karin Starzmann notes.

The fact that physicians can perceive the sick leave process as an emotionally charged and difficult challenge was plainly evident in another and qualitative substudy, based on focus group interviews with a total of 28 Primary healthcare center physicians in Västra Götaland. Interns and locum physicians also participated.

Karin Starzmann thinks that there needs to be a do-over of the sick leave issue because physicians find it so difficult. Much has been invested in various reforms and training of physicians – she trains physicians and other health care professionals in insurance medicine herself – but nevertheless, they have difficulty dealing with the sick leave issue.

Special teams proposed

"Many people still think that being a physician who issues sickness leaves is a burdensome and difficult task that requires a lot of office hours at the primary health care center. One proposal they came up with was for special teams or sick leave physicians to take care of extended sick leaves.”

This happens in many other countries, and it is also being tried in Sweden. It’s a model that, according to Karin Starzmann, can help to ensure quality and justify insurance that is called into question at times, and thus protect patients.

"I often say that sick leaves should be dispensed in the right dosage, not too much or too little. It’s important if we are to make the system work. It is also important to realize that there’s no quick fix. Many believe that there is a single solution in the case of sick leaves, but you have to take many factors into account,” Karin says.

Title: The physician and the sickness certification

Contact: Karin Starzmann

Portrait picture: Karin Starzmann (photo by Jan-Erik Lindkvist/Fotogruppen)