GPs recommend sick notes differently depending on whether a patient has a physical or mental illness, a UK study has found.

According to researchers, it appears to be ‘easier’ for people who present with physical conditions to obtain a sick note from their GP, while discussions about sick notes for mental health more often have a “taint of malingering” hanging over them.

The study analysed interactions between 506 adult patients and 13 GPs recorded in five general practices in London.  Forty-nine of the consultations included discussions, initiated by the GP, about sick notes.

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.

According to the authors, the first two communication styles indicated greater patient entitlement or legitimacy to sick notes by doctors, while the second two displayed weaker doctor endorsement.

On the whole, doctors appeared to use “endorsing statements” to patients presenting with physical symptoms and tended to use different language when patients presented with mental health issues.

“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 authors wrote.

“The roundabout 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.”

According to the researchers, discussions about sick notes ran less smoothly when doctors thought the reason for certification was a result of patient desire, as opposed to an objective medical physical need.

“Consequently the taint of malingering was not completely omitted from the discussion,” the authors noted.

While acknowledging that caution may be appropriate in discussing requests for time off work, the researchers cautioned that some styles of communication may inadvertently de-legitimise the sick note in the eyes of patients.

“[This] may be particularly important in consultations for psychosocial issues where the patient may already be feeling unsure and anxious about presenting their concerns and more sensitive to the doctors’ reactions,” the researchers said.

The authors recommend that doctors detail the negative, as well as positive consequences, of sickness leave and present additional options to time off work.

“By widening the focus of the discussion, when appropriate to do so, a more personalised course of action could be agreed, resulting in improved patient care and recovery,” they wrote.

This article was originally published in Soc Sci Med 2015; 126:48-58

23rd Feb 2015

Author – Sunalie Silva