Sick leave for subjective complaints in general practice. A mixed methods analysis of decision making

Aims. Medical decisions in the case of subjective complaints have been rarely assessed. This international comparative study has attempted to describe and understand the diagnosis decision-making and sickleave prescriptions in GP. Method. Mixed method using filmed clinical cases presented to a sample of GPs invited to provide through a questionnaire their assessment of the cases and their decisions. Two focus groups explored the internal reasoning of the sickleave decision. Result. The wide dispersion of diagnoses contrasted with the homogeneity of the sickleave decision. The latter was either hesitant, according to the patient's request, and to three modalities: therapeutic sickleave for a poorly argued pathology, compassionate sickleave with negotiated duration, or compassionate choice to leave the patient at work to avoid a chronicisation. Conclusion. Confronted with subjective health complaints, the physician's decision to prescribe or not sick leave for a patient is mostly backed up by compassionate criteria.