Affiliations: Division of Insurance Medicine, Department of Clinical
Neuroscience, Karolinska Institutet, Stockholm, Sweden | Centre for Clinical Research, Falun, Sweden | Department of Family Medicine, Uppsala University,
Uppsala, Sweden | Institute of Community Medicine, University of
Tromsæ, Norway and the Research Unit, Kalmar County Council, Sweden
Abstract: Objective: 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. Design and subjects: 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. Results: 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). Implications: 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.
Keywords: Dilemma, sick-listing, sick leave, physician, consultation, family medicine, general practitioner
