Characteristics of sick-listing cases that physicians consider problematic--analyses of written case reports.

OBJECTIVE

The aim was to discern common characteristics in the sick-listing cases that physicians in general practice and occupational health services find problematic.

DESIGN

Descriptive categorization within a narrative theoretical framework.

SETTING

Sickness-insurance course for physicians in general practice and occupational health services.

SUBJECTS

A total of 195 case reports written by 195 physicians. Main outcome measures. Categories of features regarding medical, work, and social situation as well as medical interventions.

RESULTS

Beside age and sex, the following information was often provided: family situation, stressful life events, occupation, problem at work, considerations concerning diagnoses, medical investigations, treatments, and vocational rehabilitation measures. Two-thirds of the patients had been sickness absent for more than a year. The most common type of case reports concerned women, employed in non-qualified nursing occupations, and sick listed due to mental disorders. The most common measures taken by the physicians were referrals to psychotherapy and/or physiotherapy, and prescribing antidepressants (SSRI). Facts about alcohol habits were rarely provided in the cases.

CONCLUSIONS

Some of the circumstances, such as prolonged sick-listing, are likely to be more or less inevitable in problematic sick-listing cases. Other circumstances, such as stress-full life events, more closely reflect what the reporting physicians find problematic. The categories identified can be regarded as markers of problematic sick-listing cases in general practice and occupational health service.