Variations in sick-listing practice among male and female physicians of different specialities based on case vignettes

OBJECTIVE: To analyse the influence on sick-listing of speciality and sex of the prescribing doctor and of patients' way of presenting their problem. DESIGN: A sample of 360 general practitioners (GPs), 180 psychiatrists and 180 orthopaedic surgeons were presented case vignettes and asked to fill in a sick certificate for each case. The cases were chosen to reflect common causes of sick-listing in Sweden. The vignettes for each case were presented in three versions with uniform biomedical information plus a variation in the patient's attitude to sick-listing. SETTING: Swedish general practice and hospital physicians. MAIN OUTCOME MEASURES: Proportion of cases not being sick-listed and costs for the period certified. RESULTS: The most important factor affecting sick-listing was the patient's attitude to sick-listing. Patients wishing sick-listing were sick-listed to a greater extent than those who were reluctant. In addition, GPs sick-listed more than orthopaedic surgeons and less than psychiatrists. Female doctors sick-listed more than male doctors, irrespective of speciality and patient attitude. CONCLUSION: Sick-listing is influenced by the physician's speciality and sex. Doctors are strongly influenced by how the patients present their problem.