Physicians' messages in problematic sickness certification: a narrative analysis of case reports

Area of Science:

• Medical Education
• Occupational Health
• General Practice

Background:

• Physicians frequently encounter difficulties with sickness certification tasks.
• Understanding physicians' responses to problematic certification situations is limited.
• Reflection-in-action, particularly in interpreting patient narratives, offers insight into these challenges.

Purpose of the Study:

• To explore the meaning and content of case reports concerning problematic sickness certification.
• To identify messages physicians convey to colleagues through these reports.

Main Methods:

• A narrative approach, incorporating thematic and structural analysis, was used.
• Nineteen case reports from a sickness insurance course, written by general practitioners and occupational health physicians, were analyzed.
• Narrative qualities and structural features of the case reports were examined.

Main Results:

• Five distinct message types were identified: 'a call for help', 'a call for understanding', 'hidden worries', 'in my opinion', and 'appearing neutral'.
• Physicians aimed for neutrality, often interpreting patient stories within a biomedical framework.
• Messages primarily concerned the existence of problems rather than their specific details.

Conclusions:

• Case reports illustrate diverse approaches to communicating problems in sickness certification, from neutrality to explicit requests for help.
• The findings are relevant to problematic case reporting beyond sickness certification.
• Further research into reflection-in-practice and narrative writing can inform medical education and the study of challenging consultations.