Considerations made by the general practitioner when dealing with sick-listing of patients suffering from subjective and composite health complaints

Objectives. To explore GPs'' considerations in decision-making regarding sick-listing of patients suffering from SHC. Design. Qualitative analysis of data from nine focus-group interviews. Setting. Three cities in different regions of Norway. Participants. A total of 48 GPs (31 men, 17 women; aged 32--65) participated. The GPs were recruited when invited to a course dealing with diagnostic practice and assessment of sickness certificates related to patients with composite SHCs. Results. Decisions on sick-listing patients with SHCs were regarded as a very challenging task. Trust in the patient's own story and self-judgement was deemed crucial, but many GPs missed hard evidence of illness and loss of function. Several factors that might influence decision-making were identified: the patients'' ability to present their story to evoke sympathy, the GP's prior knowledge of the patient, and the GPs'' own experience as a patient and their tendency to avoid conflicts. The approach to the task of sick-listing differed from patient-led cooperation to resistant confrontation. Conclusion and implications. Issuing sickness certification in patients with composite health complaints is considered challenging and burdensome. It is seen as mainly patient-driven, and the decisions vary according to GPs'' attitudes, beliefs, and personalities. Guiding the GPs to a more focused awareness of the decision process should be considered.