Why do doctors issue sick notes? An experimental questionnaire study in primary care.

BACKGROUND: Issuing sick notes is one of the core tasks of General Practice and yet little research has explored how doctors decide whether or not to offer a sick note. AIM: To explore what factors influence this decision with a focus on the impact of type of problem (psychological versus physical), adverse family circumstances (present versus absent) and patient demand (asks for note versus does not ask).
DESIGN: Experimental factorial design using questionnaire-based vignettes with eight scenarios which varied in terms of the three core factors.
SETTING: East and West Sussex PCTs. OUTCOME MEASURES: Doctors' beliefs about the patient and their subsequent behaviour. PARTICIPANTS: Four hundred and eighty-nine GPs completed a questionnaire asking them to rate one of eight hypothetical patients in terms of their beliefs about the patient and their hypothetical behaviour.
RESULTS: The doctors rated the patient with the psychological problem as more ill, less work-shy, more unfit for work and described feeling more sympathy towards him compared with the patient with the physical problem. The presence of adverse family circumstances generated more sympathy and doctors considered this patient as less work-shy. A patient demand for a sick note had no effect on doctors' beliefs about the patient. In terms of doctors' behaviour, the doctors were more likely to give the patient with the psychological problem a sick note overall and because they felt he needed or deserved one, and more likely to give the patient with the physical problem a sick note in order to maintain a relationship with him. The decision to give a sick note was not influenced by either adverse family circumstances or patient demand.
CONCLUSION: Doctors have more positive beliefs about patients with a psychological problem and are more likely to offer them a sick note. Issuing sick notes is unrelated to the patient's family circumstances or patient demand.