General practitioners’ description of functioning in sickness certificates

Introduction: In Norway, general practitioners (GPs) are the gatekeepers who provide written assessment of patients' functional ability to provide documentation for the Norwegian Labor and Welfare Administration for decisions about welfare benefits. This article investigates the description of functioning in sickness certificates according to the bio-psycho-social model described in WHO's International Classification of Functioning, Disability and Health (ICF). In particular, the study focuses on medical sick notes for young patients with common mental disorders. Methods: This study utilized directed content analysis, where codes were defined a priori. A simplified bio-psycho-social model with ICF as a framework was used to categorize functional assessment. 393 sick notes were analyzed in Norway between January 2018–January 2020. Results: The results show that more than half (50.4%) of the certificates contain no information about function on any level, and that the diagnosis was the only indication of a patient's function. The biological perspective was the most common description in 39,9% of the certificates, 13,5% had a description of the patient's functioning from an individual perspective. The social perspective was only adopted in 12.0% of certificates. Only 4 certificates (1.0%) described all three perspectives (biological, individual, and social) and mentioned what the individual could do despite the illness (resources). Conclusions: We find that information on functional ability is limited on sickness certificates in Norway. The descriptions given were mainly from the biological perspective and without social context, which is consistent with prior research