• Mia von Knorring, Linda Sundberg, Anna Löfgren, and Kristina Alexanderson.
• Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. mia.von.knorring@ki.se
• Scand J Prim Health Care. 2008 Jan 1; 26 (1): 222822-8.

ObjectiveTo identify what problems physicians experience in sickness certification of patients.DesignQualitative analyses of data from six focus-group discussions.SettingFour counties in different regions of Sweden.ParticipantsTwenty-six physicians strategically selected to achieve variation with regard to sex, geographical location, urban/rural area, and type of clinic.ResultsThe problems involved four areas: society and the social insurance system, the organization of healthcare, the performance of other actors in the system, and the physicians' working situation. In all areas the problems also involved manager issues such as overall leadership, organization of healthcare, and existing incentives and support systems for physicians' handling of patients' sickness certification. Many physicians described feelings of fatigue and a lack of pride in their work with sickness certification tasks, as they believed they contributed to unnecessary sickness absence and to medicalization of patients' non-medical problems.ConclusionsThe problems identified have negative consequences both for patients and for the well-being of physicians. Many of the problems seem related to inadequate leadership and management of sickness certification issues. Therefore, they cannot be handled merely by training of physicians, which has so far been the main intervention in this area. They also have to be addressed on manager levels within healthcare. Further research is needed on how physicians cope with the problems identified and on managers' strategies and responsibilities in relation to these problems. If the complexity of the problems is not recognized, there is a risk that inadequate actions will be taken to solve them.

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