The increase in certified sickness absence recorded in most European countries during the last decade is of increasing concern to public health agencies. While sickness absence can promote rest and recovery from illness, it may also have negative consequences, including increased risks of inactivity and isolation, poorer quality of life and increased uptake of health services. In the Republic of Ireland (ROI) sickness certification is part of General Practitioners’ (GPs’) contractual service to the Department of Social Protection (DSP). Sickness certificates are also issued to patients as evidence of illness for employment purposes. There is limited research exploring GPs certifying practices in the Republic of Ireland. The aim of the thesis was to explore perspectives on sickness certification in general practice in Ireland. The data collection consisted of three stages. Study 1 consisted of in depth individual interviews with 14 GPs across 11 primary care practices in Ireland. Study 2 was based on an on-line questionnaire survey using a number of vignettes with 62 GPs working in primary healthcare. Finally, study 3 consisted of a focus group conducted with eight GPs in a large urban practice in Ireland. Qualitative analysis was conducted in vivo using content and simple thematic analysis techniques. Quantitative data was analysed by descriptive and inferential statistics using PASW version 18 statistical software. Combined results indicate that GPs can find their role as certifiers’ problematic and a source of conflict during the consultation process with patients. GPs concerns are with breaching patient confidentiality and in particular disclosing illness to employers. They reported feeling inadequate in dealing with some cases requesting sickness leave, including certification for adverse social circumstances and they felt a need for better communication between themselves, employers and relevant government departments. Willingness to issue a sickness cert may be influenced by the nature of the patient’s presenting problem. A psychological problem generated greater belief that patients were unfit for work, and GPs were more sympathetic and showed greater satisfaction with the decision they had made to certify these patient in comparison to patients with a physical problem. Average sickness certification periods were longer in cases of psychological nature (1-2 weeks) in comparison to the physical complaint (4-7days). Overall GPs displayed a negative feeling towards prescribing sickness leave and there was a perception that sickness certificates were being used by employers as a management tool in controlling absenteeism. GPs also mentioned cultural factors in work place absenteeism and lack of rehabilitative pathway as impacting on sickness certification practices in Ireland. Issuing a sickness certificate appears influenced by medical and non-medical factors. Potential exists for improving the system, but requires significant engagement with other stakeholders such as employers and social benefit agencies. Focus should be placed on referral and rehabilitative pathways for patients to ensure appropriate certification and early return to work.

The purpose of this paper is to investigate and analyse the employers legal right to demand a medical certificate from an employee from the very first day in a leave of absence due to illness. Further the paper will investigate the possible consequences and repercussions that an employee faces if he or she is not willing or able to procure a medical certificate by the demand of an employer. A minor comparative study about work security during illness and sick leave in Sweden and Denmark will be carried out and analysed. To gain a broader perspective on sick leave a gender perspective will be analysed as well. The paper is largely based on a doctrinal method of traditional legal analysis. Due to the change in legislation regarding sick pay paid by employer in 2008 all employers without collective agreements gained the right to demand a medical certificate from an employee. Reasons behind the requests can vary from an early start in rehabilitation to the suspicion of unrightfully use of sick pay. The general rule in Sweden unlike Denmark is that you cannot be dismissed due to illness, and there are comprehensive obligations for an employer to partake in the rehabilitation and return to work for an employee. Permanent reduced capacity for work or lack of cooperation in the rehabilitation process by the employee stipulates exceptions for dismissal due to illness. By not procuring a medical certificate an employee could consequently face dismissal.

Employee's Health Incapacity to Work and Legal Nature of Medical Certificates Abstract This thesis is named "Employee's Health Incapacity to Work and Legal Nature of Medical Certificates." Employee's health incapacity to work has significant consequences for the master-servant relationship and these consequences are visible in the areas of creation, modification and termination of the master-servant relationship. This incapacity can also have various causes and every cause can have different labour-law consequences. Employee's health incapacity can, however, be declared only by a medical certificate or by a decision of an administrative authority, which reviews the medical certificate. Only on the basis of the above mentioned medical certificate or decision of an administrative authority which reviews the medical certificate are the employer and employee entitled to actions predicted by legislation. In recent years, there has been a change in how medical certificates are viewed upon in terms of their legal nature. Today, medical certificates are not considered as legally binding, but only as a non-binding opinion. The objective of this thesis is to describe and analyse the legal regulation of medical certificates, with extra attention being paid to the legal nature of those certificates. The goal is also to...

Syftet med studien var att ta reda på hur ett antal individer som fått besked om nekad sjukpenning trots läkarintyg upplever och hanterar sin livssituation och deras ekonomiska förutsättningar efter förlorad sjukpenning. För att besvara studiens syfte och frågeställningar genomfördes kvalitativa intervjuer med sju individer som har upplevelse av att få nekad sjukpenning trots läkarintyg. Teorierna som tillämpats i analysen var coping och stigma. Resultatet visade att majoriteten av respondenterna upplevde att de påverkats negativt av beskedet, både ur ett känslomässigt och ekonomiskt perspektiv. För att hantera sin livssituation använde respondenterna både problemfokuserade och emotionella copingstrategier. Resultatet visade även att majoriteten av respondenterna upplever sig stigmatiserade, både i samhället och av myndigheterna. En av studiens viktigaste slutsatser är att det finns brister i sjukförsäkringen. Det saknas samverkan mellan Försäkringskassan, den enskilde och andra myndigheter. Bedömningen av den enskildes sjukdom och arbetsförmåga skiljer sig också mellan läkare och försäkringskassa. / The aim of the study was to explore the experience of individuals who have been denied sickness benefit despite medical certificates and how they master life and their economy without it. To answer the questions of the study, qualitative interviews were conducted with seven individuals who have the experience of being denied sickness benefit despite medical certificates. The theories applied in analyzes were coping and stigma. Results showed that respondents felt they were negatively affected, both from an emotional and financial perspective. To manage their life situation, respondents used both problem focused and emotional coping strategies. Results showed that respondents felt stigmatized, both in society and by the authorities. Conclusion of the study is that there are shortcomings in Swedish health insurance. Collaboration is poor between social insurance agency and the individual. The assistant of the individual’s illness and ability to work differs between doctor and social insurance fund.

Arbetsuppgifterna på ett fartyg kan innefatta hård fysisk påfrestning samt arbete i mörker, påhög höjd och i slutna utrymmen vilket betyder att sjöfolk måste vara lämpliga för tjänstgöringen.De nationella reglerna för medicinsk lämplighet för sjöfolk skiljer sig trots att deninternationella standarden är densamma för alla. Syftet med denna rapport är att åskådliggöraskillnaderna mellan regelverken om läkarintyg för sjöfolk i de skandinaviska länderna ochundersöka historien bakom de svenska föreskrifterna.Vår slutsats är att det skulle gagna Sverige att återinföra Sjömansläkare, som troligtvis är merkompetenta än en icke specialiserad läkare vad gäller tjänstbarhetsbedömning för sjömän.Systemet med sjömansläkare är fortfarande i bruk och fungerar väl i både Danmark ochNorge.Slutligen sammanfattas rapporten av författarnas egna reflektioner kring ämnet i relation tillresultatet. Förslag till vidare forskning återfinns i slutet. / The duties onboard any ship include moments of hard physical labour, work in darkness, aloftand within enclosed spaces which means that a seafarer must be fit for duty. The nationalrequirements for medical fitness of seafarers differ between countries, although they are allbased on the same international standard. The aim of this report is to compare the differencesbetween the regulations concerning medical certificates for seafarers in the Scandinaviancountries and to investigate the history of the Swedish regulations.We conclude that Sweden would benefit from the reintroduction of the old system ofSeaman’s Doctors, who presumably are more competent than a doctor not specialized injudging the fitness of a seafarer. This system is still in operation and working well in bothDenmark and Norway.Finally this report consists of the authors’ own reflexions regarding the medical examinationsand certificates for seafarers. We also include a few suggestions for further research.

This study examines how the mental health care institution of Sankt Sigfrid's hospital treated women discharged between 1946–1950. This study aims to understand the mental institution as an institution of power, at work through its definitions of women as sick and as healthy. The source material used in this study is case records from Sankt Sigfrid's hospital. The results from the study show that the medical certificate with the mental history and the family history of the patients were important documents for letting women enter the hospital. The family's health background documentation showed that a majority of the women had a normal childhood. The results also show that the medical certificates and the doctors' journals were embodied with negative descriptions, about patients' family- and social history, which was needed for the diagnosis and to place the individuals into a patient category. / Denna studie belyser hur institutionen Sankt Sigfrids sjukhus behandlade kvinnor som blev utskrivna åren 1946–1950. Genom att analysera sjukjournaler och vårdattester från Sankt Sigfrids sjukhus ämnar studien att förstå hur sinnessjukvården fungerade som en maktinstitution i relation till hur kvinnor ansågs sjuka respektive friska. Resultaten av denna studie visar att vårdattesten, med patientens sjukdoms- och familjehistoria var viktiga beståndsdelar för om kvinnorna fick intas eller inte. Dokumentens information om kvinnornas familjehistoria har i analysen varit viktiga då dokumenten visat att en majoritet av kvinnorna kom från normala uppväxtförhållanden. Andra resultat i studien visar att vårdattesten och läkarnas anteckningar innehöll negativa beskrivningar av patienternas familje- och sociala historia som var nödvändiga för diagnosticering och kunna placera individen i kategorin patient.

1 Transfer of an employee to alternative work due to health reasons Abstract This thesis deals with the legal regulation of the institute of transferring an employee to alternative work due to health reasons and its related labor law contexts. The introductory chapter briefly describes the development and legal regulation of the institute of transfer of an employee to alternative work. Attention is focused on the compliance of unilateral transposition with the Charter of Fundamental Rights and Freedoms and the obligations arising from international treaties, as well as the principles of labor and civil law. In addition to that, essential terms for the further discussion of the institute of transfer of an employee are being defined: the type of work, specific description of the type of work and the employer's dispositional power. The second part of the thesis is dedicated to the legal regulation of changes in the content of the employment by agreement and unilateral legal action and in particular, by transfer. The third part focuses on the introduction of basic occupational health concepts, which are used in the following chapters focusing on transfers due to health reasons. Attention is focused mainly on the medical opinion, which is one of the most common and problematic reasons for transferring employees...