Isolated specialist or system integrated physician – different views on sickness certification among orthopaedic surgeons: an interview study

<p>Abstract</p> <p>Background</p> <p>Sickness certification is a frequent and sometimes problematic task for orthopaedic surgeons.</p> <p>Our aim was to explore how orthopaedic surgeons view their sick-listing commission and sick-listing practice.</p> <p>Methods</p> <p>Semi-structured interviews with seventeen orthopaedic surgeons from five orthopaedic clinics in four Swedish counties. The focus was on the experiences of these physicians in relation to handling of sickness certification. Phenomenographic analysis was performed to reveal differences in existing views.</p> <p>Results</p> <p>The orthopaedic surgeons' views on sick-listing seemed mainly to be a consequence of how they perceived their role in the healthcare system. Three categories were found: The "<it>isolated specialists"</it>, whose work and responsibilities were confined to the orthopaedic clinic, and did not really include sickness certification; the "<it>orthopaedic advisers"</it>, who saw themselves mainly as advice-givers in the general health care system and perceived sickness certification as part of their job; the "<it>system-integrated physicians"</it>, who perceived the orthopaedic clinic as one part of the healthcare system and whose ultimate goal was to get the patient well functioning in her life again with regained work ability, seeing sick-listing as one of the instruments to achieve this. Some informants described difficulties in handling conflicting opinions with patients in relation to the need for sick-leave.</p> <p>Conclusion</p> <p>Orthopaedic surgeons certify a large proportion of total sickness benefits. Some orthopaedic surgeons may certify sickness benefits sub-optimally for patients and society due to a narrow view of their role in the health care system or due to poor skills in handling discordant opinions with the patient. This problem can be addressed at the level of the individual physician and at the system level.</p

Views on sick-listing practice among Swedish General Practitioners – a phenomenographic study

<p>Abstract</p> <p>Background</p> <p>The number of people on sick-leave started to increase in Sweden and several other European countries towards the end of the 20^thcentury. Physicians play an important role in the sickness insurance system by acting as gate-keepers. Our aim was to explore how General Practitioners (GPs) view their sick-listing commission and sick-listing practice.</p> <p>Methods</p> <p>Semi-structured interviews with 19 GPs in 17 Primary Health Care settings in four mid-Sweden counties. Interview transcripts were analysed with phenomenographic approach aiming to uncover the variation in existing views regarding the respondents' sick-listing commission and practice.</p> <p>Results</p> <p>We found large qualitative differences in the GPs' views on sick-listing. The sick-listing commission was experienced to come either from society or from patients, with no responsibility for societal interests, or as an integration of these two views. All the GPs were aware of a possible conflict between the interests of society and patients. While some expressed feelings of strong conflict, others seemed to have solved the conflict, at least partly, between these two loyalties.</p> <p>Some GPs experienced carrying the full responsibility to decide whether a patient would get monetary sick-leave benefits or not and they were not comfortable with this situation. Views on the physician's and the patient's responsibility in sick-listing and rehabilitation varied from a passive to an empowering role of the physician.</p> <p>GPs expressing a combination of less inclusive views of the different aspects of sick-listing experienced strong conflict and appeared to feel distressed in their sick-listing role. Some GPs described how they had changed from less to more inclusive views.</p> <p>Conclusion</p> <p>The clearer understanding of the different views on sick-listing generated in this study can be used in educational efforts to improve physicians' sick-listing practices, benefiting GPs' work situation as well as their patients' well-being. The GP's role as a gatekeeper in the social security system needs further exploration. Our findings could be used to develop a questionnaire to measure the distribution of different views in a wider population of GPs.</p

Brexit: A step back in Britain’s fight against human trafficking? : A comparative content analysis of the Modern Slavery Act 2015 and the EU Directive 2011/36

Human trafficking has become an international issue of significant importance; it is the largest and most profitable organised crime after drugs and arms trafficking. Particular concern has recently been raised due to the Brexit potential ramifications on Human trafficking. There is a risk that the EU directive 2011/36 will be repealed as a result of Brexit. Accordingly, it has been questioned whether the UK national efforts and legislation concerning human trafficking are comprehensive and sufficient enough without the strengthening support of the EU and especially the EU directive 2011/36. Thus, this thesis aimed to determine the impact Brexit will have on human trafficking in the UK by investigating if there will be "gaps" in the UK national legislation on human trafficking.  A comparative content analysis was conducted to analyse the UK national legislation on human trafficking, The Modern Slavery Act 2015 (MSA 2015). The Modern Slavery Act was compared with the EU directive 2011/36 to determine how the legislation differed. The method and analysis were conducted on both a latent and manifest level which means it both described the definitions and analysed how the definitions could be interpreted, hence how it affects reality. Based on what has commonly been argued the main reasons behind human trafficking in Europe, the content analysis focused on the definitions of human trafficking, prostitution and protection of migrant victims. Prostitution and migrations are frequently claimed to be the main reasons behind human trafficking in Europe.  Due to the risk of the EU directive 2011/36 being repealed, the result of the thesis exhibits the need for the UK to update their national legislation. The MSA 2015 needs to become coherent with international agreements and strengthen the protection of victims of human trafficking. Due to the gendered nature of human trafficking, this research addressed human trafficking from a feminist perspective by applying the "dominance theory" and the "sameness theory". The feminist theories helped analyse and investigate the issue of human trafficking and the potential ramifications of Brexit. Applying the ideas illustrated the patriarchal structures surrounding human trafficking and within the MSA 2015.

The Globalisation of Democracy: The Issue or The Solution?

During the last decade, the world order seems to be planned or reconstructed by the most powerful states, in order to enforce democracy. There are numerous cases when wars were conducted in order to spread democracy, Iraq and Afghanistan are two prominent examples. The west attempt to reconstruct and change the world, through making states democratic, even though highly questionable, seems to be working. However, there are those challenging and criticizing the Western promotion of democracy and the democratisation transpiring. Thus, research investigating the consequences has become a subject of broad and current interest. Nevertheless, due to the different conceptions of democracy and different methods used in the research conducted, there is no common empirical consent demonstrating the correlation between democracy and HDI. Therefore, the aim of my research is to find out whether there is a relationship between a high level of democracy and increasing human development. In order to know, whether the promotion of democracy by the west is "for the greater good", or a way to maintain control over the rest of the world, I conducted an OLS regression. The regression confirmed my hypothesis that there is a significant relationship between the variables

Physician Sickness Certification Practice focusing on views and barriers among general practitioners and orthopaedic surgeons

There is no common understanding on what constitutes good sick-listing, a frequent and problematic task for many physicians, especially general practitioners (GPs) and orthopaedic surgeons. Aiming to achieve a deeper understanding of sick-listing practices, 19 GPs (I, III) and 18 orthopaedic surgeons (II) in four counties were interviewed, and data analysed qualitatively for views on good sickness certification and barriers to desired practice. Data from a survey of all 7665 physicians in two counties on emotionally straining problems in sickness certification (IV) was analysed quantitatively. Some GPs exposed narrow views of sick-listing, where their responsibility was limited to issuing a certificate, while GPs with the most inclusive view had a perspective of the patient’s total life-situation and aimed to help patients shoulder their own responsibility (I). The orthopaedic surgeons´ perceptions of good sick-listing were mainly related to their views on their role in the health-care system. Some perceived their responsibility as confined to the orthopaedic clinic only, while others had the ultimate goal of helping the patient to become well functioning in life with regained work capacity – by means of surgery and proper management of sick-listing (II). Difficulty handling conflicting opinions was a barrier to good sickness certification for GPs (III), and problematic for about 50% of all physicians and about 80% of GPs (IV). Orthopaedic surgeons’ handling of such situations varied from being directed by the patient, via compromising, to being directed by professional judgement (II). Other barriers included poor stakeholder collaboration (III). GPs with a workplace-policy on sickness certification reported fewer conflicts and less worry of getting reported to the disciplinary board in relation to sick-listing (IV). Understanding physicians’ underlying views on and barriers to practicing “good sick-listing” can inform efforts to change physician practice. Communications skills training in handling sick-listing situations with conflicting opinions is recommended

Physician Sickness Certification Practice focusing on views and barriers among general practitioners and orthopaedic surgeons

There is no common understanding on what constitutes good sick-listing, a frequent and problematic task for many physicians, especially general practitioners (GPs) and orthopaedic surgeons. Aiming to achieve a deeper understanding of sick-listing practices, 19 GPs (I, III) and 18 orthopaedic surgeons (II) in four counties were interviewed, and data analysed qualitatively for views on good sickness certification and barriers to desired practice. Data from a survey of all 7665 physicians in two counties on emotionally straining problems in sickness certification (IV) was analysed quantitatively. Some GPs exposed narrow views of sick-listing, where their responsibility was limited to issuing a certificate, while GPs with the most inclusive view had a perspective of the patient’s total life-situation and aimed to help patients shoulder their own responsibility (I). The orthopaedic surgeons´ perceptions of good sick-listing were mainly related to their views on their role in the health-care system. Some perceived their responsibility as confined to the orthopaedic clinic only, while others had the ultimate goal of helping the patient to become well functioning in life with regained work capacity – by means of surgery and proper management of sick-listing (II). Difficulty handling conflicting opinions was a barrier to good sickness certification for GPs (III), and problematic for about 50% of all physicians and about 80% of GPs (IV). Orthopaedic surgeons’ handling of such situations varied from being directed by the patient, via compromising, to being directed by professional judgement (II). Other barriers included poor stakeholder collaboration (III). GPs with a workplace-policy on sickness certification reported fewer conflicts and less worry of getting reported to the disciplinary board in relation to sick-listing (IV). Understanding physicians’ underlying views on and barriers to practicing “good sick-listing” can inform efforts to change physician practice. Communications skills training in handling sick-listing situations with conflicting opinions is recommended

Physician Sickness Certification Practice focusing on views and barriers among general practitioners and orthopaedic surgeons

There is no common understanding on what constitutes good sick-listing, a frequent and problematic task for many physicians, especially general practitioners (GPs) and orthopaedic surgeons. Aiming to achieve a deeper understanding of sick-listing practices, 19 GPs (I, III) and 18 orthopaedic surgeons (II) in four counties were interviewed, and data analysed qualitatively for views on good sickness certification and barriers to desired practice. Data from a survey of all 7665 physicians in two counties on emotionally straining problems in sickness certification (IV) was analysed quantitatively. Some GPs exposed narrow views of sick-listing, where their responsibility was limited to issuing a certificate, while GPs with the most inclusive view had a perspective of the patient’s total life-situation and aimed to help patients shoulder their own responsibility (I). The orthopaedic surgeons´ perceptions of good sick-listing were mainly related to their views on their role in the health-care system. Some perceived their responsibility as confined to the orthopaedic clinic only, while others had the ultimate goal of helping the patient to become well functioning in life with regained work capacity – by means of surgery and proper management of sick-listing (II). Difficulty handling conflicting opinions was a barrier to good sickness certification for GPs (III), and problematic for about 50% of all physicians and about 80% of GPs (IV). Orthopaedic surgeons’ handling of such situations varied from being directed by the patient, via compromising, to being directed by professional judgement (II). Other barriers included poor stakeholder collaboration (III). GPs with a workplace-policy on sickness certification reported fewer conflicts and less worry of getting reported to the disciplinary board in relation to sick-listing (IV). Understanding physicians’ underlying views on and barriers to practicing “good sick-listing” can inform efforts to change physician practice. Communications skills training in handling sick-listing situations with conflicting opinions is recommended