Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88 Stockholm, Sweden.
BMC Public Health. 2012 Aug 28;12:702. doi: 10.1186/1471-2458-12-702.
Physicians have an important but problematic task to issue sickness certifications. A manifold of studies have identified a wide spectrum of medical and insurance-related problems in sickness certification. Despite educational efforts aiming to improve physicians' knowledge of social insurance medicine there are no signs of reduction of these problems. We hypothesised that the quality deficits is not only due to lack of knowledge among issuing physicians. The aim of the study was to explore physicians' challenges when handling sickness certification in relation to their professional roles as physicians and to their interaction with different stakeholders.
One hundred seventy-seven physicians in Stockholm County, Sweden, participated in a sick-listing audit program. Participants identified challenges in handling sick-leave issues and formulated action plans for improvement. Challenges and responsible stakeholders were identified in the action plans. To deepen the understanding facilitators of the program were interviewed. A qualitative content analysis was performed exploring challenge categories and categories of stakeholders with responsibility to initiate actions to improve the quality of the sick-listing process. The challenge categories were then related by their content to professional competence roles in accord with the Canadian Medical Education Directions for Specialists (CanMEDS) framework and to the stakeholder categories.
Seven categories of challenges were identified. Practitioner patient interaction, Work capacity assessment, Interaction with the Social Insurance Administration, The patient's workplace and the labour market, Sick-listing practice, Collaboration and resource allocation within the Health Care System, Leadership and routines at the Health Care Unit. The challenges were related to all seven CanMEDS roles. Five categories of stakeholders were identified and several stakeholders were involved in each challenge category.
Physicians performing sickness certification tasks experience a complex variety of challenges. From physician perspective actions to handle these need to be initiated in interaction with both medical and non-medical stakeholders. The relation between the challenges and a well-established professional competence framework revealed a complex pattern. Thus, from a public health perspective, educational activities aimed to improve the sick-listing process should address all physician competences including identification and interaction with stakeholders, and not just knowledge of social insurance medicine.
医生在开具病假证明方面有一项重要但存在问题的任务。大量研究已经确定了病假证明在医学和保险方面存在广泛的问题。尽管为了提高医生对社会保险医学的认识已经付出了教育努力，但这些问题并没有减少的迹象。我们假设质量缺陷不仅是由于开具医生缺乏知识造成的。本研究的目的是探讨医生在处理病假证明时面临的挑战，这些挑战与他们作为医生的专业角色以及与不同利益相关者的互动有关。
瑞典斯德哥尔摩县的 177 名医生参加了病假登记审核计划。参与者确定了处理病假问题的挑战，并制定了改进计划。在行动计划中确定了挑战和负责的利益相关者。为了深入了解该计划的促进因素，对其进行了访谈。进行了定性内容分析，以探索挑战类别和有责任采取行动以改善病假登记流程质量的利益相关者类别。然后，根据其内容将挑战类别与加拿大医学教育专家方向（CanMEDS）框架中的专业能力角色以及利益相关者类别联系起来。
确定了七个类别的挑战。医患互动、工作能力评估、与社会保险管理局的互动、患者的工作场所和劳动力市场、病假登记实践、医疗保健系统内的协作和资源分配、医疗保健单位的领导和常规。这些挑战与所有七个 CanMEDS 角色都有关。确定了五个类别的利益相关者，每个挑战类别都涉及多个利益相关者。
执行病假证明任务的医生会遇到各种各样的复杂挑战。从医生的角度来看，处理这些问题的行动需要与医疗和非医疗利益相关者互动来启动。挑战与成熟的专业能力框架之间的关系揭示了一种复杂的模式。因此，从公共卫生的角度来看，旨在改善病假登记流程的教育活动应该涵盖所有医生的能力，包括识别和与利益相关者互动，而不仅仅是社会保险医学知识。
