D'Angelo Egidio Niclas, Kirchhoff Ralf, Halvorsen Kristin
Department of Health Sciences, Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ankeret, A316, Ålesund, Norway.
Department of Language and Literature, Faculty of Humanities, Bygg 5, 5519A, Dragvoll, Trondheim, Norway.
BMC Health Serv Res. 2025 May 20;25(1):725. doi: 10.1186/s12913-025-12902-7.
In Norway's welfare system, General Practitioners (GPs) issue sickness certificates (SCs) to document patient's inability to work. These documents serve a dual role as medical evidence and as a basis for social welfare decisions. The language used in SCs can shape how non-medical stakeholders perceive a patient's work capacity. This study examines how SC language constructs narratives of work ability, focusing on how it portrays patients' limitations and prospects for recovery.
We conducted a qualitative discourse analysis of 155 SCs written by Norwegian GPs for patients under 35 years old with common mental health conditions. We focused on certificates issued around week 39 of the patient's sick leave. Using discourse analysis techniques, we examined linguistic features that convey the patient's work capacity and functional limitations.
SCs predominantly emphasized incapacity and the necessity of work absence through discursive choices such as definitive language, amplified descriptions, and rhetorical strategies reinforcing limitations. Recovery potential was presented with tentative language, reflecting uncertainty in prognosis, while the temporal dimension of treatment was frequently framed as a barrier to returning to work. Additionally, the use of specialized terminology, generalized label, and elliptical constructions placed a significant interpretative burden on non-medical readers. Furthermore, SCs largely lacked explicit recommendations for workplace accommodations or interdisciplinary collaboration, limiting their utility in facilitating structured return-to-work strategies.
Time constraints, administrative pressures, and the dual roles of GPs as clinicians and bureaucrats shape the entire production of SCs. In turn, these discursive choices often reinforce narratives of incapacity. Enhancing SC relevance through structural modifications and interdisciplinary collaboration, including employer involvement in evaluating workplace accommodations, could improve welfare assessments and support tailored reintegration strategies. Positioning SCs as collaborative tools - rather than standalone assessments - may better align clinical evaluations with workplace realities and foster shared accountability for recovery and return-to-work efforts. SCs seem to place a disproportionate burden on GPs to translate medical conditions into work-related recommendations, often without the support or expertise required for such interdisciplinary evaluations.
在挪威的福利体系中，全科医生（GPs）开具病假证明（SCs）以证明患者无法工作。这些文件兼具医学证据和社会福利决策依据的双重作用。病假证明中使用的语言会影响非医学利益相关者对患者工作能力的认知。本研究考察病假证明语言如何构建工作能力的叙述，重点关注其如何描述患者的局限性和康复前景。
我们对挪威全科医生为35岁以下患有常见心理健康问题的患者开具的155份病假证明进行了定性话语分析。我们聚焦于患者病假第39周左右开具的证明。运用话语分析技巧，我们研究了传达患者工作能力和功能局限的语言特征。
病假证明主要通过确定性语言、放大描述以及强化局限性的修辞策略等话语选择，强调无工作能力和缺勤的必要性。康复潜力用试探性语言表述，反映出预后的不确定性，而治疗的时间维度常常被构建为重返工作的障碍。此外，专业术语、通用标签和省略结构的使用给非医学读者带来了很大的解释负担。此外，病假证明在很大程度上缺乏关于工作场所便利调整或跨学科协作的明确建议，限制了它们在促进结构化重返工作策略方面的效用。
时间限制、行政压力以及全科医生作为临床医生和官僚的双重角色塑造了病假证明的整个生成过程。反过来，这些话语选择往往强化了无工作能力的叙述。通过结构调整和跨学科协作，包括雇主参与评估工作场所便利调整，来增强病假证明的相关性，可改善福利评估并支持量身定制的重新融入策略。将病假证明定位为协作工具——而非独立评估——可能会使临床评估更好地与工作场所实际情况保持一致，并促进对康复和重返工作努力的共同责任。病假证明似乎给全科医生带来了不成比例的负担，要求他们将医疗状况转化为与工作相关的建议，而进行这种跨学科评估往往缺乏所需的支持或专业知识。
