Objectives: To explore general practitioners ’(GPs’) specific negotiation strategies regarding sick-leave issues with patientssuffering from subjective health complaints.
Design: Focus-group study.
Setting: Nine focus-group interviews in three citiesin different regions of Norway.
Participants: 48 GPs (31 men, 17 women; age 32–65), participating in a course dealing with diagnostic practice and assessment of sickness certifi cates related to patients with subjective health complaints.
Results: TheGPs identified some specific strategies that they claimed to apply when dealing with the question of sick leave for patientswith subjective health complaints. The first step would be to build an alliance with the patient by complying with the wish for sick leave, and at the same time searching for information to acquire the patient’s perspective. This position would become the basis for the main goal: motivating the patient for a rapid return to work by pointing out the positive effectsof staying at work, making legal and moral arguments, and warning against long-term sick leave. Additional solutions might also be applied, such as involving other stakeholders in this process to provide alternatives to sick leave.
Conclusions and implications: GPs seem to have a conscious approach to negotiations of sickness certification, as they report applying specific strategies to limit the duration of sick leave due to subjective health complaints. This give-and-take way of handling sick leave negotiations has been suggested by others to enhance return to work, and should be further encouraged. However, specific effectiveness of this strategy is yet to be proven, and further investigation into the actual dealings between doctorand patients in these complex encounters is needed.