Does feeling respected influence return to work? Cross-sectional study on sick-listed patients’ experiences of encounters with social insurance office staff

We found a high attributable risk (AR) for having experienced positive encounters and the patient’s feeling respected. Being listened to and being believed were among the types of behaviour with the highest AR (Table 2).

Of those with experience of positive encounters, 26.9% (95% CI: 22.1-31.7) stated that it facilitated their self-estimated ability to return to work. This ability was significantly increased if they also felt respected [49.3% (47.5-51.1)]. In particular, patients with psychiatric disorders estimated that their ability to return to work was significantly improved when they felt respected (Table 3).

The risk of feeling wronged if exposed to negative encounters was found to be high. The highest AR was linked with being treated with nonchalance, being disbelieved, and having one’s condition doubted (Table 4).

Of those with experience of negative encounters, 29.1% (24.6-33.6) stated that these experiences impeded their ability to return to work. A significantly greater proportion of the respondents who in addition felt wronged described themselves as impeded from returning to work [51.3% (47.1-55.5)]. Compared to patients suffering from somatic disorders, more patients with mental disorders reported this effect when also feeling wronged (Table 5).

We found no significant differences based on sex or social status concerning the different aspects discussed above.

Our survey regarding encounters with social insurance office staff also collected data regarding patients’ encounters with healthcare staff, published elsewhere [17, 23, 24]. Regarding positive encounters and feeling respected, a majority of encounter items yielded significantly higher ARs among social insurance staff compared to healthcare staff. Also, negative encounters and feeling wronged displayed a tendency for social insurance staff to score higher ARs [17, 23]. The few items which had significantly higher ARs are rather interesting. The long-term sick-listed seem to feel that it is worse if the staff at a social insurance office question their motivation to work, reject their suggested solutions, or threaten them. How can these differences be explained? Compared to healthcare staff, who are primarily concerned with patients’ health, social insurance office staff have other tasks associated with societal, economic, and regulatory interests. It is part of their job to assess their clients’ right to sickness benefit. Being questioned on this matter implies a threat to the income of the concerned individuals and can therefore become a very sensitive matter in that context. This might explain the attitude towards having one’s willingness to work questioned or one’s suggestions for handling the situation rejected. Perhaps the threats experienced concern financial actions that social insurance office staff might take if the client does not behave in accordance with requirements.

When comparing positive encounters associated with long-term sick-listed individuals’ feeling of being respected by social insurance office staff or healthcare staff, we identified several significant differences. The respondents stated that it is more important that social insurance office staff believe in them and in their ability to work, let them take responsibility, and make reasonable demands, compared to healthcare staff doing so. Again, these differences might be explained by the different roles of social insurance office staff and healthcare staff.

Patients might react differently to the same kinds of encounters, depending on their personal sensitivity and circumstances [12]. Sometimes healthcare staff and social insurance office staff might be provoked or intimidated by patients/clients and confrontations might occur [25]. Studies have indicated that it is unreasonable to assume that healthcare staff intentionally wrong patients [26]. Similar reasoning might be plausible when discussing social insurance office staff. Yet both professional groups need to become aware of what kinds of encounters are negatively experienced by patients and might cause them to feel wronged. Even if patients’ perceptions do not always correspond to objective negative or wrongful behaviour, these perceptions need to be taken seriously, because they seem to have consequences, for example effects on patients’ self-estimated ability to return to work. Apparently the quality of encounters is not solely a matter of etiquette.

There were also differences in the encounters’ perceived effect on return to work. However, when comparing the two contexts, we found no significant difference regarding feeling wronged and self-estimated effect on return to work. Nevertheless, for positive encounters in which patients also felt respected, the behaviour of healthcare staff was more commonly perceived than that of social insurance office staff as facilitating return to work. Yet the impact in the latter case is not negligible, according to the respondents’ self-estimations.

Even without considering the consequences for return to work, it seems reasonable to promote encounters that facilitate individuals’ feeling of being respected and avoid encounters that make them feel wronged. When this aspect is also considered, the reasons become even stronger. From the perspective of positive encounters and feeling respected, social insurance staff ought particularly to avoid questioning patients’ work morality, rejecting their suggested solutions, making unreasonable demands, and threatening the patient.

The present study was a cross-sectional study, with its inherent limitations. Although the response rate was relatively high, there was also an internal drop-out that should be taken into consideration. The internal dropout rate increased in every combined step (Figure 1).

The focus was on long-term sick-listed patients’ encounters with social insurance office staff and the self-estimated effects of these encounters on return to work. Although self-estimated work-capacity might influence actual capacity, self-estimated effects and actual effects on return to work are distinct entities. The results should therefore be interpreted carefully about the effects of positive and negative encounters on actual return to work. Furthermore, we cannot generalize from these results to individuals who have no experience of long-term sick leave. Yet, our results suggest a focus for future research.

The fact that respectful encounters were most frequent and strongest associated with feeling respected is no surprise – the whole purpose of including this item was to validate the questionnaire. Accordingly, we have not considered it in the discussion. Disrespectful encounters were used in a corresponding vein in relation to feeling wronged.