General practitioners' relationship to sickness certification

Objective. GPs' role conflict in connection with sickness certification is widely accepted. The authors explored the relationship between GPs and this difficult task. Design. Cross-sectional questionnaire study of experiences, attitudes, and management of sickness certification. Data were analysed by hierarchical cluster analysis. Setting. Norway. Subjects. Representative sample of 308 general practitioners from a nationwide panel established by the Research Institute of the Norwegian Medical Association. Main outcome measures. Differentiation of response patterns regarding perceived burden, self-evaluation, doubt, permissiveness, opinions on whether sickness certification is a medical task, and sociopolitical attitude. Associations with hours of patient contact per week, number of sickness certifications per week, job satisfaction, degree of paternalism, and personality characteristics. Results. Four groups evolved, one (12%) with low burden, high self-esteem, little doubt, and permissiveness, another (12%) with the opposite characteristics. They displayed similar sociopolitical attitudes. The third group (32%) was primarily characterized by a biomedical attitude, while the fourth represented a middle position in all dimensions. The first two groups differed on personality characteristics. There were no differences between groups regarding number of sickness certifications per week, job satisfaction, or degree of paternalism. Conclusions. Prominent differences in experiences with sickness certification between groups of doctors exist. No evidence was found of associations between group-level GP differences and sickness certification rates.