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Practices used for recommending sickness certification by general practitioners: A conversation analytic study of UK primary care consultations

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  • Wheat, Hannah C.
  • Barnes, Rebecca K.
  • Byng, Richard

Abstract

Existing research indicates that many patients and doctors find the process of negotiating sickness certification for time off work to be a difficult one. This study examined how patients and general practitioners (GPs) managed these negotiations in a sample of UK primary care consultations. The study made use of an existing dataset of audio-recorded consultations between 13 GPs and 506 unselected adult patients in five general practices in London. Forty-nine consultations included discussions for both initial and repeat sickness certification across a wide range of conditions. Here we report our findings on doctor practices for recommending, as opposed to patient practices for advocating for, sickness certification (n = 26 cases). All cases were transcribed in detail and analysed using conversation analytic methods. Four main communication practices were observed: (1) declarative statements of need for sickness certification; (2) ‘do you need’ offers for sickness certification; (3) ‘do you want’ offers for sickness certification; and (4) conditional ‘If X, Y’ offers for sickness certification. These different communication practices indexed doctor agency, doctor endorsement and patient entitlement to varying degrees. In the main, recommendations to patients presenting with biomedical problems or a repeat occurrence of a psychosocial problem displayed stronger doctor endorsement and patient entitlement. Contrastingly, recommendations to patients presenting with new psychosocial and biopsychosocial problems, displayed weaker endorsement and patient entitlement. This study offers new evidence to support the Parsonian argument that becoming sick involves entering a social role with special rights and obligations. Through documenting doctors' orientations to their gatekeeping role as well as patients' orientations to differential rights vis à vis legitimacy, we demonstrate the contrasting stances of doctors in situ when giving sick notes for biomedical problems as opposed to difficulties of a more psychosocial nature.

Suggested Citation

  • Wheat, Hannah C. & Barnes, Rebecca K. & Byng, Richard, 2015. "Practices used for recommending sickness certification by general practitioners: A conversation analytic study of UK primary care consultations," Social Science & Medicine, Elsevier, vol. 126(C), pages 48-58.
    • Handle: RePEc:eee:socmed:v:126:y:2015:i:c:p:48-58
    DOI: 10.1016/j.socscimed.2014.12.006
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    References listed on IDEAS

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    1. Hudak, Pamela L. & Clark, Shannon J. & Raymond, Geoffrey, 2011. "How surgeons design treatment recommendations in orthopaedic surgery," Social Science & Medicine, Elsevier, vol. 73(7), pages 1028-1036.
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    Cited by:

    1. Thomas Leoni, 2015. "Wirkmodell Krankenstand," WIFO Studies, WIFO, number 58579.
    2. Thomas Leoni & René Böheim, 2018. "Fehlzeitenreport 2018. Krankheits- und unfallbedingte Fehlzeiten in Österreich – Präsentismus und Absentismus," WIFO Studies, WIFO, number 61487.
    3. Felicity Thomas & Lorraine Hansford & Joseph Ford & Katrina Wyatt & Rosemarie McCabe & Richard Byng, 2018. "Moral narratives and mental health: rethinking understandings of distress and healthcare support in contexts of austerity and welfare reform," Palgrave Communications, Palgrave Macmillan, vol. 4(1), pages 1-8, December.
    4. Kushida, Shuya & Kawashima, Michie & Abe, Tetsuya, 2021. "Recommending no further treatment: Gatekeeping work of generalists at a Japanese university hospital," Social Science & Medicine, Elsevier, vol. 290(C).

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