Occupational stress: a survey of management in general practice.

OBJECTIVES To identify approaches to and barriers associated with the management of patients with work-related stress by general practitioners (GPs). DESIGN Cross-sectional postal survey using a self-administered questionnaire which included a case vignette of a patient with work-related stress and questions ascertaining perceived barriers to the effective general practice management of work-related stress. PARTICIPANTS AND SETTING 450 Western Australian GPs on the mailing list of a GP journal. The survey was conducted between 22 March and 28 April 2000. MAIN OUTCOME MEASURES Likelihood that GPs would (i) choose to open a workers compensation claim and (ii) provide time off work for the patient described in the vignette. RESULTS Response rate was 50.1%. Eighty-five percent (95% CI, 79.6%-19.7%) of respondents advised the hypothetical patient to take time away from work; however, only 44.0% (95% CI, 37.2%-50.7%) chose to initiate a workers compensation claim. GPs with training or experience in occupational health were less likely to advise the patient to stay away from work (odds ratio [OR], 0.30; 95% CI, 0.12-0.73), but were just as likely to initiate a claim. GPs were reluctant to involve the employer in management decisions, because of concern about patient confidentiality and the potential to make matters worse for the patient. These, and the adversarial nature of the workers compensation system, were the strongest perceived barriers to effective management of the condition. CONCLUSIONS Our findings indicate that general practitioners take a pragmatic and varied approach to the management of work-related stress. The perceived difficulties with contacting employers challenges the principles of injury management within a workers compensation system which is dependent on liaison between system stakeholders.