A study which has for the first time investigated in ‘real time’ how GPs approach the negotiation of sick notes, has found doctors taking a differing stance with patients who have mental health problems compared with those who present with physical illness.

The study was carried out by researchers from Plymouth University Peninsula Schools of Medicine and Dentistry and the School of Social and Community Medicine at the University of Bristol and was published this month in Social Science and Medicine.

The results of the study come at a time when the UK Government has announced a fit-for-work scheme designed to crack down on the so-called “sick note culture”.

The study analysed interactions between 506 unselected adult patients and 13 GPs recorded in five general practices in London. Of those, 49 consultations included discussions about sickness certification - both for the first time for some patients and repeat certification for others.

The study identified four main ways that doctors recommended certification, including: statements of need for certification; “do you need” offers of certification; “do you want” offers, and; conditional offers. The first two indicate a greater patient entitlement.

In the main, the recommendations made to patients presenting with physical symptoms showed stronger doctor endorsement and patient entitlement. The recommendations made to patients presenting with mental health issues displayed weaker doctor endorsement and patient entitlement.

A short hand interpretation of these findings would suggest that it is easier to obtain a sick note if a patient presents with physical symptoms, than for those who present with mental illness. This is likely to reflect the complex two-way relationship between mental illness and worklessness which both patients and GPs may be aware of.

Professor Richard Byng from Plymouth University Peninsula Schools of Medicine and Dentistry, commented: “We undertook this study because these negotiations were clearly strained and nuanced. Our findings show that it appears to be ‘easier’ to get a sick note for physical conditions, yet it would be remiss to accept this at face value. Patients presenting with mental health issues require a more complex response from their GP, as being off work can, in different situations, be either harmful or helpful to mental health. The round-about way in which patients elicited offers of sick notes from GPs, and the low entitlement indicated in the GPs’ offers suggests that both parties may have been aware of the complex social pressures being played out in the consulting room.”

He added: “The new fit-for-work scheme, being piloted at the moment, if sensitive to individual patients’ needs, may provide valuable support to patients and make these difficult encounters easier for all.”

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Andrew Gould
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University of Plymouth

Journal
  Social Science and Medicine