Engblom Monika, Alexanderson Kristina, Englund Lars, Norrmén Gunilla, Rudebeck Carl Edvard
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Work. 2010;35(2):137-42. doi: 10.3233/WOR-2010-0965.
Many physicians find sick-listing tasks problematic. The aim of this study was to identify categories of dilemmas experienced by physicians in their sick-listing practice.
Data was collected at courses that were aimed at improving physicians' sick-listing skills, arranged in different parts of Sweden. Before the course the participants, general practitioners (GP) sent in a written report of a sick-listing case they found problematic. The material consisted of group discussions of some 100 case reports from GPs. The process of categorisation of the dilemmas was a one-step, straightforward qualitative analysis.
Eight different categories of sick-listing dilemmas experienced by the physicians were identified. Examples of them are "Not the doctors' pigeon" (when the patients' problem was perceived as not being medical in nature), "Diagnosis as disguise" (when there is a discrepancy between how the patient describes the problems and what the physician apprehends), and "Harmed by sick listing-reversible" (when the physician perceives that the main problem is the iatrogenic adverse effects of sick listing per se).
The contribution of the study is to provide understanding of and labels to the specific difficulties experienced by physicians in their sick-listing practice face to face with patients.
许多医生发现开具病假条的任务存在问题。本研究的目的是确定医生在开具病假条实践中所经历的困境类别。
数据收集于瑞典不同地区举办的旨在提高医生开具病假条技能的课程。在课程开始前，参与者，即全科医生（GP）提交一份他们认为有问题的病假条案例的书面报告。材料包括对约100份全科医生案例报告的小组讨论。对困境进行分类的过程是一个一步到位的直接定性分析。
确定了医生所经历的八种不同类型的病假条开具困境。例如“不是医生的职责”（当患者的问题被认为本质上不是医疗问题时）、“诊断为伪装”（当患者描述的问题与医生所理解的存在差异时）以及“因开具病假条而受到伤害——可逆转的”（当医生认为主要问题是开具病假条本身的医源性不良反应时）。
该研究的贡献在于让人们了解医生在与患者面对面开具病假条实践中所遇到的具体困难，并为这些困难提供了分类标签。
