The social negotiation of fitness for work

Tensions in doctor-patient relationships over medical certification of chronic pain.

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

The UK government is promoting the health benefits of work, in order to change doctors’ and patients’ behaviour and reduce sickness absence. The rationale is that many people ‘off sick’ would have better outcomes by staying at work; but reducing the costs of health care and benefits is also an imperative. Replacing the ‘sick note’ with the ‘fit note’ and a national educational programme are intended to reduce sickness certification rates, but how will these initiatives impact on doctor-patient relationships and the existing tension between the doctor as patient advocate and gate-keeper to services and benefits? This tension is particularly acute for problems like chronic pain where diagnosis, prognosis and work capacity can be unclear. We interviewed 13 doctors and 30 chronic pain patients about their experiences of negotiating medical certification for work absence and their views of the new policies.

Our findings highlight the limitations of naïve rationalist approaches to judgements of work absence and fitness for work for people with chronic pain. Moral, socio-cultural and practical factors are invoked by doctors and patients to contest decisions, and although both groups support the fit note’s focus on capacity, they doubt it will overcome tensions in the consultation. Doctors value tacit skills of persuasion and negotiation that can change how patients conceptualise their illness and respond to it. Policy-makers increasingly recognise the role of this tacit knowledge and we conclude that sick-listing can be improved by further developing these skills and acknowledging the structural context within which protagonists negotiate sick-listing.
Original languageEnglish
Pages (from-to)17-33
Number of pages17
JournalHealth
Volume19
Issue number1
Early online date11 May 2014
DOIs
Publication statusPublished - 1 Jan 2015

Fingerprint

Negotiating
Certification
fitness
Chronic Pain
certification
pain
illness
Insurance Benefits
Persuasive Communication
Illness Behavior
persuasion
Administrative Personnel
educational program
Referral and Consultation
health care
Costs and Cost Analysis
costs
health
Values
experience

Keywords

  • chronic pain
  • doctor-patient relationship
  • fit note
  • sick-listing

Cite this

@article{15b771628caa45d0ab3e053794527948,
title = "The social negotiation of fitness for work: Tensions in doctor-patient relationships over medical certification of chronic pain.",
abstract = "The UK government is promoting the health benefits of work, in order to change doctors’ and patients’ behaviour and reduce sickness absence. The rationale is that many people ‘off sick’ would have better outcomes by staying at work; but reducing the costs of health care and benefits is also an imperative. Replacing the ‘sick note’ with the ‘fit note’ and a national educational programme are intended to reduce sickness certification rates, but how will these initiatives impact on doctor-patient relationships and the existing tension between the doctor as patient advocate and gate-keeper to services and benefits? This tension is particularly acute for problems like chronic pain where diagnosis, prognosis and work capacity can be unclear. We interviewed 13 doctors and 30 chronic pain patients about their experiences of negotiating medical certification for work absence and their views of the new policies.Our findings highlight the limitations of na{\"i}ve rationalist approaches to judgements of work absence and fitness for work for people with chronic pain. Moral, socio-cultural and practical factors are invoked by doctors and patients to contest decisions, and although both groups support the fit note’s focus on capacity, they doubt it will overcome tensions in the consultation. Doctors value tacit skills of persuasion and negotiation that can change how patients conceptualise their illness and respond to it. Policy-makers increasingly recognise the role of this tacit knowledge and we conclude that sick-listing can be improved by further developing these skills and acknowledging the structural context within which protagonists negotiate sick-listing.",
keywords = "chronic pain, doctor-patient relationship, fit note, sick-listing",
author = "Elaine Wainwright and David Wainwright and Edmund Keogh and Chris Eccleston",
year = "2015",
month = "1",
day = "1",
doi = "10.1177/1363459314530738",
language = "English",
volume = "19",
pages = "17--33",
journal = "Health",
issn = "1363-4593",
publisher = "Sage Publications",
number = "1",

}

TY - JOUR

T1 - The social negotiation of fitness for work

T2 - Tensions in doctor-patient relationships over medical certification of chronic pain.

AU - Wainwright, Elaine

AU - Wainwright, David

AU - Keogh, Edmund

AU - Eccleston, Chris

PY - 2015/1/1

Y1 - 2015/1/1

N2 - The UK government is promoting the health benefits of work, in order to change doctors’ and patients’ behaviour and reduce sickness absence. The rationale is that many people ‘off sick’ would have better outcomes by staying at work; but reducing the costs of health care and benefits is also an imperative. Replacing the ‘sick note’ with the ‘fit note’ and a national educational programme are intended to reduce sickness certification rates, but how will these initiatives impact on doctor-patient relationships and the existing tension between the doctor as patient advocate and gate-keeper to services and benefits? This tension is particularly acute for problems like chronic pain where diagnosis, prognosis and work capacity can be unclear. We interviewed 13 doctors and 30 chronic pain patients about their experiences of negotiating medical certification for work absence and their views of the new policies.Our findings highlight the limitations of naïve rationalist approaches to judgements of work absence and fitness for work for people with chronic pain. Moral, socio-cultural and practical factors are invoked by doctors and patients to contest decisions, and although both groups support the fit note’s focus on capacity, they doubt it will overcome tensions in the consultation. Doctors value tacit skills of persuasion and negotiation that can change how patients conceptualise their illness and respond to it. Policy-makers increasingly recognise the role of this tacit knowledge and we conclude that sick-listing can be improved by further developing these skills and acknowledging the structural context within which protagonists negotiate sick-listing.

AB - The UK government is promoting the health benefits of work, in order to change doctors’ and patients’ behaviour and reduce sickness absence. The rationale is that many people ‘off sick’ would have better outcomes by staying at work; but reducing the costs of health care and benefits is also an imperative. Replacing the ‘sick note’ with the ‘fit note’ and a national educational programme are intended to reduce sickness certification rates, but how will these initiatives impact on doctor-patient relationships and the existing tension between the doctor as patient advocate and gate-keeper to services and benefits? This tension is particularly acute for problems like chronic pain where diagnosis, prognosis and work capacity can be unclear. We interviewed 13 doctors and 30 chronic pain patients about their experiences of negotiating medical certification for work absence and their views of the new policies.Our findings highlight the limitations of naïve rationalist approaches to judgements of work absence and fitness for work for people with chronic pain. Moral, socio-cultural and practical factors are invoked by doctors and patients to contest decisions, and although both groups support the fit note’s focus on capacity, they doubt it will overcome tensions in the consultation. Doctors value tacit skills of persuasion and negotiation that can change how patients conceptualise their illness and respond to it. Policy-makers increasingly recognise the role of this tacit knowledge and we conclude that sick-listing can be improved by further developing these skills and acknowledging the structural context within which protagonists negotiate sick-listing.

KW - chronic pain

KW - doctor-patient relationship

KW - fit note

KW - sick-listing

U2 - 10.1177/1363459314530738

DO - 10.1177/1363459314530738

M3 - Article

VL - 19

SP - 17

EP - 33

JO - Health

JF - Health

SN - 1363-4593

IS - 1

ER -