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GPs should consider 'societal costs' when signing patients off sick

GPs should consider the wider societal costs of signing someone off sick, relating to the costs of work absenteeism, researchers have concluded.

Researchers at Keele University found that issuing patients a ‘fit note’ for low-back pain so they can take time off work does not necessarily help improve their recovery in terms of their pain, functioning or well-being.

The study included over 800 patients who went to their GP with low-back pain, 14% of whom had a record of sickness certification while the remaining 86% did not.

Six months after their initial consultation, there was little difference in patients’ self-reported pain, functioning or general well-being between those signed off sick and those not, after adjusting for the severity of the problem at baseline, the team reported.

Differences in health costs were small, but people with sickness certification were significantly more likely to take time off work and cost around £2,000 more on average in ‘productivity losses’ over the six months.

The researchers concluded: ‘This study has provided no clear evidence that issuing of sickness certificates confers any major advantages or disadvantages in respect of patient improvements in clinical outcomes or healthcare costs.

‘However, from a broader societal perspective, primary care clinicians and policymakers may wish to consider the higher societal costs as well as the ethical/moral issues of sickness certification within patient care.’

J Occup Rehabil 2015; available online 17 January

Readers' comments (19)

  • Abolish primary care certs and move the cost of assment to employeres occupational health dept, or jobcentre etc.Oh I forgot GPs are looked upon as a cheap provider of these services.I am not societie policeman.

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  • Yes researchers. Great conclusion. Moral issues? Please, I have 20 more sick patients to see.

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  • Part of the problem is (anecdotally) employers often seem totally unable to accept any level of reduced activity without a 'doctors note', I.e. We don't want to be sued under health and safety, so either work 100% or don't work (with a doctors note). There is no middle ground. Doctors notes may not help the patient get better quicker (other than allowing rest how could it anyway) but without it the patient will be forced to work in an unsafe way that will cause them to get worse.

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  • Further to my comment above - I've also lost count of how many patients have asked me for a sick note for < 7 days absence because their employer refuse to accept a self certificate, even though it's legal statute (until I tell the patient to point this out to them).

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  • I once saw a patient who claimed to be unable to sit or stand and therefore wanted to be signed off work. As an aside I asked them about all the shopping bags they were carrying to be told they had been out in town buying christmas presents all day....
    After declining a certificate a formal complaint was issued against me and the certificate was issued anyway.

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  • A patient who limped in on crutches for her certificate left her purse on the table. When I realized this, I grabbed the purse and went after her. Had a bloody job catching up with her as she was running towards Tescos. Gasping, when I caught up with her, she went red in the face and explained that she was worried her daughter had waited too long in the store and hence she had managed a sprint.
    There was a time not so long ago when you had a sheet in the sick note pad which you could send to job centre if you suspected malingering and this would trigger an assessment. We don't have these anymore and there is no substitute either. Certification should be part of the employer's domain and OH and not for GPs to police.

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  • It's fine to say "GPs should consider wider costs" but in practice there is absolutely no incentive for GPs to do so.

    Note refused = longer consultation, more doctor stress, higher likelihood of patient coming back next day / doctor shopping, higher likelihood of complaint.

    With regard to refusing antibiotics (a potentially similar situation), there is at least evidence that refusing an antibiotic makes a patient less likely to attend next time.

    I'm not aware of any comparable benefit to a GP of refusing a sick note.

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  • Means tested benefits create a society based on judging others.
    Medical fitness is part of this.
    If you give me the power to instigate universal basic income I would never have to sign people off again, and employers would have incentives to retain their employees, who otherwise might work less or elsewhere.
    Well done for you research paper Keele but please, leave out the recommendations until you have a stronger understanding of the economics of individual behaviour and of a welfare state (or at least have worked in any of the systems you are studying!).

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  • 8.50am
    You had grounds to decline the med cert, so why, with a formal complaint, was it issued.?!
    This is how we've allowed primary care to be turned into 'consumer is always right' and those that complain and shout get what they want.
    It's a sad reflection on society, and we are allowing this. Stand up to these demands, the med cert was not justified medically and you even had the observations to support such a position!

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  • Compulsory non evidence based manual handling that many patients do promotes the concept that backs are fragile, easily injured and work is to blame. Hence patients think they need time off and try to sue employers. Appallingly even the NHS promotes this stuff even though Cochrane review says useless. GP can't easily challenge these 'official' messages in 10 min.

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