Introduction
Method
Participants
Focus group A, n/N | Focus group B, n/N | Focus group C, n/N | Total, n/N | |
---|---|---|---|---|
Gender | ||||
Male | 3/7 | 4/7 | 4/9 | 11/23 |
Female | 4/7 | 3/7 | 5/9 | 12/23 |
Age, mean (SD) | 57.0 (5.7) | 57.1 (4.6) | 51.1 (8.2) | 54.7 (7.1) |
Disability | ||||
Physical disability | 6/7 | 4/7 | 4/9 | 14/23 |
Mental disability | – | 2/7 | 4/9 | 6/23 |
Physical and mental disability | 1/7 | 1/7 | 1/9 | 3/23 |
Procedure
Data analysis
Results
Coding framework
Methods to obtain information concerning person-related factors
Method | Citation examples |
---|---|
Diary | Participant B3: “When you have those invisible consequences and, as a doctor, you want to find out: what is it? Fellow sufferers I know have sometimes compiled a weekly schedule. Every half hour. With a lot of gaps. Then the doctor asks: what are the gaps? They are the rest breaks I need. This could help you to find out what the weekly schedule of that man or woman is roughly like. And draw conclusions from that.” |
Questionnaire | Participant A6: “A checklist is also always dangerous, because it only lists the answers that you have never thought of before, but you never have room, or often don’t have room, to write down what you are experiencing or what you have not thought of.” Participant A5: “(…) And who reads it? I’m not going to write everything down if I don’t know who will read it.” |
Discussing factors within consultations | Participant A5: “(…) So if I have good contact with someone and feel that I’m able to speak out, that also gives you a sense of security.” |
Prerequisites for obtaining information during consultations
Prerequisites | Citation examples |
---|---|
Mutual trust between employee and physician | Participant B5: “(…) I agree with you: there needs to be an element of trust in the first instance and only then you can engage in discussion. Otherwise you can’t.” Participant C5: “So when it comes to the point where you are discussing personal factors, things really close and personal, then there needs to be a bond of trust.” |
Showing interest and involvement | Participants B4 and B2: “You want to be seen as a human being and not…” “…Just as a number.” |
Understanding | Participant C5: “(…) And that he acknowledges that you have those fears. That it’s normal and that you can talk about it. I think that really helps a lot.” |
Positive influences on the development of conversations concerning person-related factors
Positive influences | Citation examples |
---|---|
Communication skills of the physician
| |
Listening | Participant B1: “That people judge instead of remaining open and listening, because if they listen to you they’ll soon hear that you would very much like to go to work.” |
Asking open questions | Participant B6: “Don’t ask closed questions.” |
Explaining what is realistic and defining boundaries | Participant A5: “(…) I think it’s good if the occupational physician makes an effort to.. yes, generate some kind of awareness in someone. About what is genuinely realistic.” |
Focusing on getting better instead of returning to work | Participant A2: “(…) The patient’s first priority is recovery. And… I think that that should also be something that the occupational physician focuses on. The first priority is to get better or if you can’t get better to learn to deal with the situation you’re in.” |
Coaching and offering help | Participant A5: “I don’t need to hand over control, I consider it my responsibility, but coach me, I’m very willing.” |
Setting small goals | Participant C6: “If the occupational physician maybe looks at his home situation, what he’s doing at that moment and then sets small targets to see what progress can be made and what problems he faces. Then you can also see, yes, whether there is progress and whether he can take on certain things. And also where his problems lie, what’s going wrong.” |
Expressing appreciation | Participant B5: “(…) But it’s important to keep hearing that you’re on the right track. That’s good.” |
Context of the conversation
| |
Taking enough time | Participant A3: “Particularly here I think, that’s why I feel that it’s so important to invest time at the start, because you don’t usually discuss it in the first meeting but if you actually invested time in the first meeting, it might be easier to broach in the third of fourth meeting (…)” |
Atmosphere of the conversation | Participant C1: “But the first thought that came to mind was: it really makes a difference what atmosphere you are entering.” |
Knowledge of the physician
| |
Having knowledge about the employee | Participant B5: “The better you know the person sitting opposite you, and that it’s great if you know who is sitting opposite you. What are your hobbies? Because if you can’t work, but you do walk to your vegetable patch every day, so to speak. It must be possible to make some kind of link and then you can connect it back to your work.” |
Having knowledge about problems/complaints of the employee | Participant B3: “(…) Try to get to the bottom of what that person is really suffering from.” |
Having knowledge about the working environment of the employee | Participant A3: “I think it may be easier to engage in discussion with an occupational physician if they make it clear that they understand the company and your working environment.” |
Communication skills of the physician
Context of the conversation
Knowledge of the physician
Negative influences on the development of conversations concerning person-related factors
Negative influences | Citation examples |
---|---|
Negative influences of the occupational health and social security systems
| |
Physician not being accessible | Participant C3: “Here, things are arranged in such a way that you’re obliged to make an appointment with the occupational physician via the consultant. Otherwise, you just don’t have access.” |
Lack of contact with physicians | Participant C2: “(…) After six months or a year, I was still ill and then had completely different occupational physicians again, and I didn’t have to go to the labor expert anymore because they said the situation was clear. And then suddenly I don’t hear anything anymore.” |
Employees being allocated different physicians | Participant C2: “(…) That’s right, because I never spoke to the same doctor again throughout the entire process. (…). I’m always dealing with different people, so I, I just don’t know them.” |
Focus on money | Participant C1: “Putting the employee first—I have the feeling that it is more about putting costs first.” |
Not taking into account the reduced income of the employee | Participant C8: “Everyday aspects of life are often forgotten. That you have a loss of income and a family to support and have to get by on 70% and it often gets forgotten what all that involves (…)” |
Employees not receiving adequate information about the process | Participant C1: “I have no idea who I’m going to speak to or when.” |
Negative influences of the physician
| |
Lack of physician time | Participant C2: “(…) I don’t know if they’ll manage it in the time that he has.” |
Not asking about person-related factors | Participant C1: “Some questions aren’t even asked by the occupational physician.” |
Exerting too much pressure to return to work | Participant A2: “(…) Yes, all that guy ever does is try to get me back to work as soon as possible… I say nothing, because he may actually be able to find a gap that (…)” |
Negative influences of the employee
| |
Anxiety in general | Participant A7: “(…) I do feel anxious in one-to-one discussions with the occupational physician.” |
Anxiety about disability assessment | Participant C2: “(…) But now I find I’m bracing myself for the UWV (Employee Insurance Agency) doctor who will assess me.” |
Anxiety about disclosing information | Participant B7: “I’m not honest about that. I pretend there’s nothing wrong with me.” |
Negative influences of the employer
| |
Communication/cooperation between employer and physician | Participant C1: “And I think that an occupational physician if he would have an independent position, and not be paid by the employer or the UWV. But genuinely independent, just like a general practitioner.” |
Conflicts between employer and employee | Participant C2: “(…) And before that I had a job with a manager who was an absolute monster. I would have preferred to have reported sick back then, something along the lines of: I’ve got you, than at the place where I was working at the time I reported sick.” |