Raising work concerns in primary care consultations for musculoskeletal conditions: a qualitative study

The Problem:
Musculoskeletal conditions affect a person’s ability to work, resulting in reduced productivity, sickness absence and long-term work incapacity. An ageing workforce is likely to exacerbate this. Consequently, there is a need to identify optimal ways to provide support to patients with musculoskeletal problems in primary care. Previous research has highlighted inefficient support systems for patients with work-related issues and a need to explore further the barriers to successful support. Moreover, insufficient research exists exploring the individually differing and complex work-related issues of older adults (50 +) living with musculoskeletal conditions.
The study aimed to explore barriers to the optimal management of musculoskeletal conditions and work-related concerns within the primary care consultation, as well as the patient’s experiences of the clinical encounter.
The approach:
100 video recorded GP consultations, in which work related difficulties were discussed, were sampled from an existing dataset and analysed utilizing constructivist grounded theory. A purposive sample of 20 patients aged over 50 years were identified from a cohort study (having indicated experiences of both musculoskeletal conditions and work related issues and given consent to further contact) and subsequently 19 of the patients were interviewed utilizing a semi-structured approach to explore patient perspectives on consulting for musculoskeletal problems. A comparative analysis of the two data sets is underway.
Findings:
Preliminary analysis has highlighted key themes including; 1) the normalisation or dismissal of work-related concerns as a barrier to support, 2) the patient struggle to negotiate legitimacy and deservedness as a barrier to both consulting and discussing work concerns and 3) the socio-cultural co-construction of credibility and deservedness to consult and raise work.
Work-related discussions are often tokenistic and initiated by GPs and patients as a tool to provide contextual examples of disruption to everyday life, or to assign causal explanation to a condition. Response to concerns raised by patients that were work-related and ongoing, were often normalised, re-directed elsewhere or dismissed by GPs.
The theoretical framework of ‘Candidacy’ is being utilized to explore and expand on the difficulties faced by patients in negotiating access to the consultation and work-related discussions. Patients and GPs engage in a shared and active process of legitimating consulting, which is facilitated by the recursive nature of past consultations and experiences and the biomedical approach to the consultation.
Patients struggle to raise work concerns via socio-culturally informed perceptions such as; moral worthiness to consult and stigmatised constructions of sickness certification.
Consequences:
Difficulties experienced by patients in raising work within the consultation can restrict patients with musculoskeletal conditions from receiving appropriate and adequate support. The findings may have implications for clinical practice and highlight a need to increase patient awareness of the support systems available to them.