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Literal Tricks of the Trade: The Possibilities and Contradictions of Swedish Physicians’ Everyday Resistance in the Sickness Certification Process
Södertörn University, School of Culture and Education, Centre for Studies in Practical Knowledge. Södertörn University, Centre for Baltic and East European Studies (CBEES), Baltic & East European Graduate School (BEEGS).
2020 (English)In: Journal of Resistance Studies, ISSN 2001-9947, Vol. 6, no 1, p. 8-39Article in journal (Refereed) Published
Abstract [en]

This article deals with the ways Swedish General practitioners (GPs) informally deal with the stricter standards of sickness certification and the implications of understanding these ways in terms of ‘resistance.’ In recent decades, procedural and bureaucratic changes within the Swedish sickness benefit system have curtailed physicians’ clinical discretion with regards to the sickness benefit approval for patients. By both formal and informal means, the Swedish Social Insurance Agency (SSIA) has consolidated its power over the decision-making process. Despite widespread dissatisfaction among physicians with the current system, acts of open defiance do not seem to occur. However, as shown in a recent qualitative study, Swedish General practitioners have developed informal ‘techniques’ (ranging from simple exaggerations in the certificates to complex constructions of apparent objectivity) for intentionally circumventing the stricter sickness certification standards. Taking that study as a point of departure, this article will consider the use of techniques as a form of everyday resistance. Three dimensions of ambiguity arise which require further attention, namely: (1) the multiple motives and shifting target of resistance; (2) the complex blend of power and powerlessness which defines the situation of GPs and their resistance, and (3) the fundamental ambiguity of the resistant act of issuing sickness certificates tactically, as a particular mix of compliance and resistance.

Place, publisher, year, edition, pages
Irene Publishing , 2020. Vol. 6, no 1, p. 8-39
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Work Sciences Peace and Conflict Studies Other Social Sciences not elsewhere specified
Research subject
Critical and Cultural Theory; Baltic and East European studies
Identifiers
URN: urn:nbn:se:sh:diva-44008OAI: oai:DiVA.org:sh-44008DiVA, id: diva2:1528024
Funder
The Foundation for Baltic and East European StudiesAvailable from: 2021-02-12 Created: 2021-02-12 Last updated: 2025-02-20Bibliographically 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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