The paper from Wynne-Jones et al on sickness certification rates is timely and adds to the evidence on this field in the UK. I note, however, a couple of minor errors with reference to the research we undertook a few years ago in the UK on the same topic.1 We also collected data on actual sicknotes not, as stated in the discussion, the use of incapacity reports as a proxy. We were able to track consecutive and separate periods of sickness absence from an anonymised database of over 13 000 sicknotes of around 7000 patients in a 1-year prospective sicknote survey across 10 practices. We were looking for data on risk factors that increased the risk of entering longer-term absence and incapacity, but used sicknote data to do that. The other citation of our work2 relates to a secondary analysis of our database where we demonstrated the differential risk of longer-term absence depending on gender interaction in the consultation — and while European data (as the UK is in Europe), it was our 2004 paper that was the first to report the preponderance of mild mental health problems over musculoskeletal disorders as the greatest cause of sickness absence. I presume this is a drafting error, but perhaps it is important to clarify that this paper is further evidence on UK certification practice from records, not the first ever. However, a common problem with our databases is that it is not possible to distinguish those in employment from those on benefit using either of these methods. It is to be hoped that the recent NICE guidance (that recommends this) and the forthcoming introduction of the electronic fit for work note due to replace the MED3 and 5 in 2010, promotes more systematic recording of patients' occupation, work capacity, and role in records, particularly when capacity for work is a subject of the consultation.
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