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Occupational Medicine Advance Access originally published online on March 17, 2009
Occupational Medicine 2009 59(5):347-352; doi:10.1093/occmed/kqp031
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© The Author 2009. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Inside the fitness for work consultation: a qualitative study

D. A. Cohen1, M. Aylward1 and S. Rollnick2

1 Centre for Psychosocial and Disability Research, School of Psychology, Cardiff University, 51a Park Place, Cardiff CF10 3AT, UK
2 Department of Primary Care and Public Health, School of Medicine, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN, UK

Background Evidence now suggests that work is generally good for physical and mental health and well-being. Worklessness for whatever reason can lead to poorer physical and mental health. The role of the general practitioner (GP) in the management of fitness for work is pivotal.

Aims To understand the interaction between GP and patient in the fitness for work consultation. This study forms part of a larger research project to develop a learning programme for GPs around the fitness for work consultation based on behaviour change methodology.

Methods A qualitative study set in South Wales. Structured discussion groups with seven GPs. Two sessions each lasting 3 h were conducted to explore the GP and patient interaction around the fitness for work consultation. Multiple methods were used to enhance engagement. Thematic analysis was used to analyse the data.

Results Four major themes emerged from the meetings: role legitimacy, negotiation, managing the patient and managing the systems. Within these, subthemes emerged around role legitimacy. ‘It's not my job’, ‘It's not what I trained for’ and the ‘shifting agenda’ Negotiation was likened to ‘A polite tug of war’ and subthemes around decision making, managing the agenda and dealing with uncertainty emerged.

Conclusions This study starts to unravel the complexity of the fitness for work consultation. It illustrates how GPs struggle with the ‘importance’ of their role and ‘confidence’ in managing the fitness for work consultation. It addresses the skilful negotiation that is required to manage the consultation effectively.

Keywords      Behaviour change; physician–patient relationship; sickness certification

Correspondence to: D. A. Cohen, Centre for Psychosocial and Disability Research, School of Psychology, Cardiff University, 51a Park Place, Cardiff CF10 3AT, UK. Tel: +44 2920 879311; fax: +44 2920870196; e-mail: cohenda{at}cf.ac.uk


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