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Eur J Gen Pract. 2012 Dec;18(4):219-28. doi: 10.3109/13814788.2012.727795.

Difficulties with the sickness certification process in general practice and possible solutions: a systematic review.

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Department of General Practice, University of Lyon 1, France.



Prescription of sick leave periods is a common but complex task in general practice in many countries.


The objective was to identify issues around sickness certification and solutions aimed at improving this process.


Through Medline, Cochrane, and Web of Science bibliographic databases, 56 relevant original articles in English or French were retrieved, focusing on the certification process in general practice. Data was synthesized using a thematic analysis.


The various issues identified were difficulties in assessing the need for sick leave and its length, difficulties in the doctor-patient relationship, and difficulties related to healthcare system organization and to the socioeconomic environment. Some possible solutions to these difficulties have been assessed either for validity or effectiveness. In particular, patient functional assessment or cooperation with occupational practitioners could help in adjusting the sick periods. Guidelines or legislative reforms on sickness certification could only potentially improve the filling in of certificates.


Sickness certification represents a procedural as well as a relational, organizational and political challenge. Well-validated tools or procedures to support doctors in this task are lacking. The development of functional assessment and cooperation with occupational practitioners requires appropriate training and education for present and future GPs. Further research is needed to refine these strategies, which should be tailored to each country.

[Indexed for MEDLINE]

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