Is medical certification a legitimate task for a general practitioner?

Does the legitimacy of the task affect the person performing it? The simple answer is that it works. The fact that a task is legitimate by definition means that the person performing it considers it meaningful and that you yourself have the appropriate aptitude to perform it. The higher the degree of legitimate tasks a person possesses, the more likely the person is to feel good about their work and experience a good work environment, while the opposite – that is, a high degree of illegal tasks (those that are perceived as meaningless or that someone else can perform with the skills of Copes better with the task) – carries a risk of negative stress and a poor psychosocial work environment (1-4).

As a healthcare professional, you are trained in assessing, treating, and caring for patients. This is the essence of the business and something that most people experience as highly legitimate. What has happened in recent decades is that healthcare professionals in all occupational groups have been allowed to devote an increasing proportion of their time to administrative tasks rather than to ill work (5,6). The reasons for this are numerous, but one of the main reasons is the increasing role of documentation, reporting and recording in health care (7).

In a time study we conducted in primary care, perhaps the largest of its kind, that we present in the book Paper, Money and Patients (6), we detailed the working hours of all employees in eleven health centers (1.8). The study showed, for example, that clinicians devoted on average only a third of them to directing a patient’s work, roughly the same amount to a patient’s indirect work (such as documentation, referrals, testimonials, etc.), and the remaining third to other predominant types. Administrative tasks. The study showed an inverse relationship between the patient’s direct work rate and the experience of performing unreasonable work tasks, and a direct relationship between these tasks and the negative psychological and social work environment.

To give an example of what illicit work tasks could be, I would like to start from the very common phenomenon of documenting capacity for work, a task that for the average general practitioner has over the years become an intense daily routine.

Let me first start by saying one thing: If, as a physician, I take a patient on sick leave, it is because – based on my medical skills – I’m judging that the person in question is really incapacitated. If I hadn’t thought about it, I wouldn’t have taken sick leave either.

However, health insurance, in an effort to raise the increasing rates of sickness, has been tightened over the years so that only those who cannot truly work are entitled to sickness benefits, and the reasons for this must be carefully. It is justified for officials to be able to determine who, based on testimony, is qualified for this or not.

One can find this to be true and proper. Having a disease does not automatically mean that you cannot work. Often times, as medical professionals, we are informed from various quarters of the dangers of taking patients on sick leave – as if this were surprising news for us. This, of course, is not at all the case. On the contrary, it is an equally clear part of all other medical situations, in the same way that we are well aware of the risks of various medications or surgical procedures. It’s about weighing the side effects against the benefits and the risks against the necessity.

But the result is that I, as a doctor, have to spend a lot of time explaining in the medical certificate why the patient cannot work; Why, for example, those with severe back pain are unable to fulfill their hospice duties, or why those who have received tennis elbow cannot fulfill their obligations as a carpenter. It may seem obvious, but not least in different pain states, it can be somewhat impossible. How do you really appreciate pain, and this individual is in more pain than the other, so painful that you cannot function? There are no objective methods of verifying pain, so regardless of the number of examinations and tests that they take, the patient’s description of pain ends in a medical certificate, as is the case with many other manifestations that cannot be measured through any objective methods, such as anxiety, stress and depression ( For those who want, there are countless rating scales to choose from, but all of them are mainly based on the patient’s medical history.) In some people anxiety shines in the eyes, in others it does not. Some complain of pain, others bite.

And the words needed to do that have become countless.

Of course I know what to write. What words and formulas should I choose for the recipient to be satisfied. And I use it. It is not at all about manipulating or spreading the truth. But I have already made an assessment that the individual to whom the certificate applies is unable to work; It is just a matter of justification for my position, and that in the words I know is important for the person making the decision.

Suddenly, without anyone really wanting, a kind of invisible tug-of-war arose – a war of words where I as a physician write more and more detailed explanations of why an individual could not actually function. At the same time, with the Social Insurance Agency, as disease rates continue to rise, it continues to tighten requirements, interpret testimonies more strictly, and ask what you wrote.

Ironically, it turns out that, as one of the many overburdened and in many places with a severe shortage of medical personnel, I spend a large portion of my time proving with detailed testimonials that people are sick, rather than dedicating this value and having costly time helping people recover. .

Besides the purely ergonomics, there is also an economic aspect. At present, around 10,000 physicians work in primary care. If one starts from the unfounded (but certainly not illogical) assumption that they spend an average of two hours a week crafting long texts in various certificates to the Swedish Social Insurance Agency, this results in 800,000 hours of work per year, Or 20,000 weeks full-time, or 500 full-time jobs. Add this to the additional costs incurred by patients due to lack of access to primary care, forcing them to seek emergency care or exacerbating their chronic illnesses and needing hospital care. Not to mention the time when Försäkringskassan officials have to dedicate the overwhelming task of reviewing all these certifications, instead of dedicating their time and competence to rehabilitating working life, which would be more appropriate.

If it is easy to question the validity of my medical evaluation as a doctor – by people of different competencies (non-medical) and without meeting the patient myself – then is this task for me as a doctor legitimate? Or will it not be as easy as someone else’s?

Basically, I might not think so. But the truth is that the task that most doctors should consider legitimate has been awarded an extremely high degree of illegality. And we still implement it wholeheartedly.

The question is whether we can afford it.

At the moment we certainly don’t have it.

Magnus FalkSpecialist in general medicine, Vårdcentralen Kärna, Linköping. Assistant Professor, Department of Health, Medicine and Welfare, Linköping University.