Family
doctors feel disillusioned with the sickness certification system and many
would like to see their ‘gatekeeper’ role removed, according to new research.
Researchers
conducted 11 focus groups with 67 GPs in Scotland to explore how they operate
the sickness certification system, their views on the system, and suggestions
for change.
A
self-certification scheme exists under which any employee can sign his or her
own sickness certificate for up to seven consecutive days. After that period,
they can visit their doctor for a signed sickness certificate.
GPs
believed the system failed to address complex, chronic, or doubtful cases. They
described various ways of operating the system, but in practice, most operated
a "sick certificate on demand" system.
Almost
all GPs felt that they were endangering the doctor-patient relationship when
challenging or confronting patients about sickness absence. One said: "How
can we act as policeman, friend, social worker and all the rest of it? We
can’t."
There
was some misuse of the system by general practitioners for reasons such as
patient confidentiality, stress, demands on time, and disillusionment with the
system. Many experienced contradictory demands from other stakeholders and
often felt caught between their advocate role as a doctor and their role as a
judge.
Suggestions
for change included a self-assessment system akin to current taxation self
assessment, other healthcare workers providing sick certificates to patients,
the streamlining of forms, better occupational health and rehabilitation, sick
line clinics, and copying other countries’ systems.
These
findings have several implications for policymakers planning both future
research and strategies, said the authors. If the gatekeeper system is
continued, problems must be resolved.
www.bmj.com
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