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Doctors that "doctor" sickness certificates: cunning intelligence as an ability and possibly a virtue among Swedish GPs
Södertörn University, School of Culture and Education, Centre for Studies in Practical Knowledge.
2020 (English)In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 23, p. 445-456Article in journal (Refereed) Published
Abstract [en]

The relations of power between healthcare-related institutions and the professionals that interact with them are changing. Generally, the institutions are gaining the upper hand. Consequently, the intellectual abilities necessary for professionals to pursue the internal goods of healthcare are changing as well. A concrete case is the struggle over sickness benefits in Sweden, in which the Swedish Social Insurance Agency (SSIA) and physicians are important stakeholders. The SSIA has recently consolidated its power over the sickness certificates that doctors issue for their patients. The result has been a stricter gatekeeping of sickness benefits. In order to combat the inroads made by state institutions into sickness certification, and into the sphere of medical practice, some doctors have developed cunning "techniques" to maximize the chance to have their sickness certificates accepted by the SSIA. This article attempts to demonstrate that cunning intelligence-the ability of the weak to "outsmart" a stronger adversary-plays an important role in the practice of medicine. 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.

Place, publisher, year, edition, pages
Springer, 2020. Vol. 23, p. 445-456
Keywords [en]
Cunning intelligence, Medical practice, Metis, Phronesis, Practical knowledge, Sickness certification
National Category
Educational Sciences Philosophy Nursing
Identifiers
URN: urn:nbn:se:sh:diva-40691DOI: 10.1007/s11019-020-09954-3ISI: 000531227100001PubMedID: 32388666Scopus ID: 2-s2.0-85084374040OAI: oai:DiVA.org:sh-40691DiVA, id: diva2:1430135
Available from: 2020-05-13 Created: 2020-05-13 Last updated: 2025-10-07Bibliographically 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: 2025-10-07Bibliographically approved

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Shutzberg, Mani

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