[Physician and expert--a conflict situation? General practitioners work with disability pension's errands in a time of restraint policy].

OBJECTIVE

To study how general practitioners perceive their role and conduct their work as certifying physicians for patients applying for disability pension, with emphasis on effects of the revision of the law in 1991 which narrowed the medical criteria for eligibility.

DESIGN

Personal in-depth interviews, tape recorded for qualitative analysis.

SUBJECTS AND SETTING

24 general practitioners in the city of Trondheim and rural communities in the county of Møre og Romsdal.

OBSERVATIONS

Attitudes and behaviour varied considerably: On one side "the patient's advocate" strived for what he considered to be the best overall result for his patient--as opposed to "the consultant", who regarded himself as neutral and loyal to the policy makers. Narrowing the medical eligibility criteria for disability pension was perceived as reducing the doctor's influence on the outcome of an application. Many "consultants" welcomed the revision. Some "advocates" sought to counteract the loss of influence on the patient's situation through various coping strategies related to the medical certificate. Others intensified the search for alternative solutions to the patient's problems. A third strategy implied leaving the "advocate's" involvement in favour of a more disengaged role in order to make ideals meet with reality.

CONCLUSIONS

Many certifying physicians seem to have been under considerable pressure, owing to the conflicting interests of patients and authorities, and we ask whether, under such conditions, the typical doctor tends to adopt a more "bureaucratic" and less "hippocratic" role.