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Unsanctioned techniques for having sickness certificates accepted: a qualitative exploration and description of the strategies used by Swedish general practitioners
Södertörn University, School of Culture and Education, Centre for Studies in Practical Knowledge.
2019 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, no 1, p. 10-17Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To explore informal and unsanctioned techniques general practitioners (GPs) employ as a means to increase the likelihood of sickness certificate approval, following the Swedish Social Insurance Agency's (SSIA's) consolidation of the gatekeeping role in sickness benefit evaluation.

DESIGN: Qualitative semi-structured interviews with 20 GPs working in Swedish primary care. A thematic analysis of the transcribed material was carried out to map different techniques employed by the practitioners.

RESULTS: Eight techniques were identified, particularly with respect to the way in which the sickness certificate is written to ensure approval by the SSIA. The identified techniques were most commonly adopted when the patient's case was perceived to be at high risk for rejection by the SSIA (such as psychiatric illnesses, chronic pain etc.).

CONCLUSIONS: The findings imply that the informal and unsanctioned techniques are complex and ambiguous. They are used intentionally and covertly. The study also suggests that, while the consolidation of SSIA's gatekeeping role may have resolved some sickness absence issues, a consequence may be that GPs develop unsanctioned techniques to ensure compliance.

Place, publisher, year, edition, pages
Taylor & Francis, 2019. Vol. 37, no 1, p. 10-17
Keywords [en]
Family practice, Sweden, non-compliance, praxis, qualitative research, sickness certification
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:sh:diva-37543DOI: 10.1080/02813432.2019.1569426ISI: 000462849900003PubMedID: 30689481Scopus ID: 2-s2.0-85060872064OAI: oai:DiVA.org:sh-37543DiVA, id: diva2:1285959
Funder
The Foundation for Baltic and East European StudiesAvailable from: 2019-02-05 Created: 2019-02-05 Last updated: 2021-05-24Bibliographically approved
In thesis
1. Tricks of the Medical Trade: Cunning in the Age of Bureaucratic Austerity
Open this publication in new window or tab >>Tricks of the Medical Trade: Cunning in the Age of Bureaucratic Austerity
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Being a “good” doctor nowadays involves more than having virtues and capacities conducive to the content of encounters between physicians and patients. Physicians can and must be able to act on the surrounding conditions of the doctor-patient encounter, in order to keep external interests at bay. Hence, the patient-related virtues, such as compassion, prudence, temperance and the like might not constitute sufficient cause for “good” doctoring. Resistance against the invasion of external interests requires another set of capacities. In this compilation thesis, one such capacity is explored: cunning. While certainly not part of the repertoire of skills in relation to the patient, cunning intelligence is an indispensable “virtue” of good doctoring insofar as doctors must cleverly navigate institutions that block off paths toward the ultimate ends of healthcare. The role of cunning is examined through a particular case, namely, the struggle over social insurance, especially sickness benefits (“sjukpenning”), and the complex relationship between physician, patient and the Swedish Social Insurance Agency (“Försäkringskassan”). In these times of increased austerity, physicians have honed skills, retaining thereby good medical practice, and by extension also maintaining the integrity of the patient-related virtues of medicine. In the empirical material, techniques were identified, particularly with respect to the way in which the sickness certificate is written to ensure approval by the SSIA. Based on these findings, the ambiguities, contradictions and possibilities inherent in the cunning resistance of physicians are analyzed and problematized. Despite its many issues, what doctors do when issuing sickness certificates in this particular way, is certainly motivated and carried out by more than mere ignorance. Cunning intelligence is not merely a defective form of prudence (phronesis), nor is it simply an instance of instrumental reason (techne), but rather an ability that occupies a distinct place among the intellectual abilities generally ascribed to professionals. Finally, I explore if the use of these capacities indicates a change in the doctor-patient relationship. I argue that both doctor and patient are conditioned by an equality in powerlessness—the hallmark of “the age of bureaucratic parsimony”, which can be appropriately described in terms of solidarity between comrades.

Place, publisher, year, edition, pages
Huddinge: Södertörns högskola, 2021. p. 193
Series
Södertörn Doctoral Dissertations, ISSN 1652-7399 ; 194
National Category
Philosophy, Ethics and Religion
Research subject
Critical and Cultural Theory; Baltic and East European studies
Identifiers
urn:nbn:se:sh:diva-45429 (URN)978-91-89109-78-0 (ISBN)978-91-89109-79-7 (ISBN)
Public defence
2021-09-24, MA648, Alfred Nobels allé 7, Huddinge, 13:00 (Swedish)
Opponent
Supervisors
Funder
The Foundation for Baltic and East European Studies
Available from: 2021-09-01 Created: 2021-05-24 Last updated: 2021-11-02Bibliographically approved

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