The hard moral work of raising work in the primary care consultation

Common health complaints such as mental health problems and musculoskeletal disorders now account for approximately two-thirds of sickness absence, long-term incapacity and early retirement. However, the differing and complex work issues of older adults (50 +) living with musculoskeletal (MSK) disorders are insufficiently explored. Similarly, research on how MSK disorders in relation to work are managed in primary care is scarce. Moreover, the wider context with the recent changes that have seen a symbolic shift from ‘sickness’ certification to ‘fit’ notes, as well as welfare and healthcare reforms, shape primary care management and patient experiences of work-related MSK consultations.
This research aims to examine the co-construction of work problems within the primary care consultation for those who have MSK disorders. Strategies of negotiation and legitimisation of such problems, patient experiences and contextual factors will also be investigated.
Analysis of 196 video-recorded consultations will be conducted using thematic analysis initially, with a coding frame constructed through careful viewing of the videos. Examination will focus upon identifying the style and content of the discourse, discussions between General Practitioners (GPs) and patients when ‘work’ is mentioned in the consultation and GPs’ strategies for addressing work issues.
Approximately twenty patients will be purposively selected from an existing study having indicated some form of MSK problem and experience of work-related issues. In-depth interviews regarding consultations will be conducted. A comparative analysis of the observations and interviews will then be undertaken.
Analysis of the consultations and interviews has commenced and preliminary findings will be presented.