Haldorsen E M, Brage S, Johannesen T S, Tellnes G, Ursin H
Department of Biological and Medical Psychology, University of Bergen, Norway.
Scand J Rheumatol. 1996;25(4):224-32. doi: 10.3109/03009749609069991.
Concepts of disease, illness (being ill), and criteria for issuing sickness certificate for musculoskeletal pain have been investigated by a postal survey based on case histories. Questionnaires were filled in by 898 individuals; 194 General Practitioners, 76 medical consultants working for the National Insurance Administration, 307 insurance clerks, and a representative sample (N = 321) of the general public. The concepts disease and illness are meaningful and used consistently by medical doctors for infectious disease and somatic problems. Discrepancies between the medical profession representatives and the general public were, in general, attributable to differences in information and knowledge about these somatic conditions. However, for musculoskeletal pain all groups had conceptual problems. In particular, there was a lack of consensus for issuing sickness certificates. For musculoskeletal pain conditions the doctors, as a group, seemed to score at random or 50-50 level for sickness certification. All groups, including medical doctors, were reluctant to accept depression and social problems as diseases, or to accept social problems as reasons for sickness certification. The decision criteria should be identified and systematized in order to establish whether it is possible to reach a consensus for subjective complaints.
通过基于病历的邮政调查，对疾病概念、患病（生病）以及开具肌肉骨骼疼痛病假证明的标准进行了研究。898人填写了问卷，其中包括194名全科医生、76名在国家保险管理局工作的医学顾问、307名保险职员以及一般公众的一个代表性样本（N = 321）。疾病和患病概念对医生而言，在用于传染病和躯体问题时是有意义且一致的。一般来说，医学专业代表与普通公众之间的差异可归因于对这些躯体状况的信息和知识差异。然而，对于肌肉骨骼疼痛，所有群体都存在概念问题。特别是在开具病假证明方面缺乏共识。对于肌肉骨骼疼痛状况，作为一个群体的医生在开具病假证明时似乎是随机打分或处于五五开的水平。所有群体，包括医生，都不愿将抑郁症和社会问题视为疾病，也不愿将社会问题作为开具病假证明的理由。应确定并系统化决策标准，以确定是否有可能就主观诉求达成共识。
