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Assessing work capacity - reviewing the what and how of physicians' clinical practice.

Journal article
Authors Paula Nordling
Gunilla Priebe
Cecilia Björkelund
Gunnel Hensing
Published in BMC family practice
Volume 21
Issue 1
ISSN 1471-2296
Publication year 2020
Published at Institute of Medicine, School of Public Health and Community Medicine
Language en
Keywords Physicians, Review, Sick leave, Work ability, Work capacity evaluation
Subject categories Family Medicine


Although a main task in the sickness certification process, physicians' clinical practice when assessing work capacity has not been thoroughly described. Increased knowledge on the matter is needed to better understand and support the certification process. In this review, we aimed to synthesise existing qualitative evidence to provide a clearer description of the assessment of work capacity as practiced by physicians.Seven electronic databases were searched systematically for qualitative studies examining what and how physicians do when they assess work capacity. Data was analysed and integrated using thematic synthesis. Twelve articles were included. Results show that physicians seek to form a knowledge base including understanding the condition, the patient and the patient's workplace. They consider both medical and non-medical aspects to affect work capacity. To acquire and process the information they use various skills, methods and resources. Medical competence is an important basis, but not enough. Time, trust, intuition and reasoning are also used to assess the patient's claims and to translate the findings into a final assessment. The depth and focus of the information seeking and processing vary depending on several factors. The assessment of work capacity is a complex task where physicians rely on their non-medical skills to a higher degree than in ordinary clinical work. These skills are highly relevant but need to be complemented with access to appropriate resources such as understanding of the associations between health, work and social security, enough time in daily work for the assessment and ways to better understand the patient's work place. Also, the notion of an "objective" evaluation is questioned, calling for a greater appreciation of the complexity of the assessment and the role of professional judgement.

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