患有严重医学无法解释的身体症状而请病假的员工：对职业健康医生来说是负担还是常规？一项横断面研究。

Sick-listed employees with severe medically unexplained physical symptoms: burden or routine for the occupational health physician? A cross sectional study.

机构信息

University Medical Center Groningen, Department of Health Sciences, University of Groningen, The Netherlands.

出版信息

BMC Health Serv Res. 2010 Nov 8;10:305. doi: 10.1186/1472-6963-10-305.

DOI:10.1186/1472-6963-10-305

PMID:21059232

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2991306/

Abstract

BACKGROUND

The two primary objectives of this study were to the assess consultation load of occupational health physicians (OHPs), and their difficulties and needs with regard to their sickness certification tasks in sick-listed employees with severe medical unexplained physical symptoms (MUPS). Third objective was to determine which disease-, patient-, doctor- and practice-related factors are associated with the difficulties and needs of the OHPs.

METHODS

In this cross-sectional study, 43 participating OHPs from 5 group practices assessed 489 sick-listed employees with and without severe MUPS. The OHPs filled in a questionnaire about difficulties concerning sickness certification tasks, consultation time, their needs with regard to consultation with or referral to a psychiatrist or psychologist, and communication with GPs. The OHPs also completed a questionnaire about their personal characteristics.

RESULTS

OHPs only experienced task difficulties in employees with severe MUPS in relation to their communication with the treating physician. This only occured in cases in which the OHP attributed the physical symptoms to somatoform causes. If they attributed the physical symptoms to mental causes, the OHPs reported a need to consultate a psychiatrist about the diagnosis and treatment.

CONCLUSIONS

OHPs experience few difficulties with their sickness certification tasks and consultation load concerning employees with severe MUPS. However, they encounter problems if the diagnostic uncertainties of the treating physician interfere with the return to work process. OHPs have a need for psychiatric expertise whenever they are uncertain about the psychiatric causes of a delayed return to work process. We recommend further training programs for OHPs. They should also have more opportunity for consultation and referral to a psychiatrist, and their communication with treating physicians should be improved.

摘要

背景

本研究的两个主要目的是评估职业健康医生（OHPs）的咨询量，以及他们在处理患有严重医学无法解释的身体症状（MUPS）的请病假员工的病假证明任务时的困难和需求。第三个目的是确定哪些疾病、患者、医生和实践相关因素与 OHPs 的困难和需求相关。

方法

在这项横断面研究中，来自 5 个小组实践的 43 名参与的 OHPs 评估了 489 名患有和不患有严重 MUPS 的请病假员工。OHPs 填写了一份关于病假证明任务困难、咨询时间、他们对咨询精神病医生或心理学家的需求以及与全科医生沟通的问卷。OHPs 还填写了一份关于他们个人特征的问卷。

结果

OHPs 仅在与治疗医生沟通时，在患有严重 MUPS 的员工中遇到任务困难。这仅发生在 OHPs 将身体症状归因于躯体形式原因的情况下。如果他们将身体症状归因于精神原因，则 OHPs 报告需要咨询精神病医生进行诊断和治疗。

结论

OHPs 在处理患有严重 MUPS 的员工的病假证明任务和咨询量方面遇到的困难较少。然而，如果治疗医生的诊断不确定性干扰了重返工作岗位的过程，他们会遇到问题。每当 OHPs 对延迟重返工作岗位过程的精神原因不确定时，他们就需要精神病学专业知识。我们建议为 OHPs 提供进一步的培训计划。他们还应该有更多的咨询和转介精神病医生的机会，并且应该改善他们与治疗医生的沟通。