• Silje Maeland, Erik L Werner, Marianne Rosendal, Ingibjorg H Jonsdottir, Liv H Magnussen, Stein Atle Lie, Holger Ursin, and Hege R Eriksen.
• Uni Health, Uni Research , Bergen , Norway.
• Scand J Prim Health Care. 2013 Dec 1; 31 (4): 227234227-34.

ObjectivesThe primary objective of this study was to explore whether general practitioners (GPs) in Norway, Sweden, and Denmark make similar or different decisions regarding sick leave for patients with severe subjective health complaints (SHC). The secondary objective was to investigate if patient diagnoses, the reasons attributed for patient complaints, and GP demographics could explain variations in sick leave decisions.DesignA cross-sectional study.MethodVideo vignettes of GP consultations with nine different patients.Subjects126 GPs in Norway, Sweden, and Denmark.SettingPrimary care in Norway, Sweden, and Denmark.Main Outcome MeasureSick leave decisions made by GPs.Results"Psychological" diagnoses in Sweden were related to lower odds ratio (OR) of granting sick leave than in Norway (OR = 0.07; 95% CI = 0.01-0.83) Assessments of patient health, the risk of deterioration, and their ability to work predicted sick leave decisions. Specialists in general medicine grant significantly fewer sick leaves than non-specialists.ConclusionSick-leave decisions made by GPs in the three countries were relatively similar. However, Swedish GPs were more reluctant to grant sick leave for patients with "psychological" diagnoses. Assessments regarding health-related factors were more important than diagnoses in sick-leave decisions. Specialist training may be of importance for sick-leave decisions.

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