Forskningsgruppe i fysioterapi


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Give and take in sick leave negotiations

A focus-group study involving 2 researchers from the Department of Global Public Health and Primary Care (IGS) found that General Practitioners (GPs) seem to consciously negotiate when dealing with sick leave issues.

general practitioner


Norway has higher levels of sick leave than other OECD (Organisation for Economic Co-operation and Development) countries. Absence from work has social and economic costs. The government is thus concerned, and initiatives are being introduced to try to control the situation. Presently GPs are responsible for providing the medical premises for sick leave.

GPs, themselves, report that it is challenging and frustrating to make decisions regarding patients with subjective health complaints. In this study, Adjunct Professor, Kirsti Malterud, from the General Practice research group at IGS, and Associate professor II, Liv Heide Magnussen, from IGS’ Physiotherapy Research Group, together with other colleagues, aim to explore GP negotiation strategies regarding sick leave issues in patients with subjective health complaints. The authors believe that insights into GP experiences could provide input for initiatives to improve sick leave assessment standards.

Street level bureaucracy

While authorities may voice concerns about social and economic phenomena, it is ultimately public servants, such as teachers, police officers, social workers, GPs etc., who interact directly with the public and thereby represent the frontlines of government policy. This is “street level bureaucracy”, a phrase coined by public administration expert, Michael Lipsky. The government may wish that the level of sick leave would decrease, but it is the GPs who must carry out this policy. GPs find decisions concerning sick leave one of their most demanding tasks. They struggle with the lack of objective measures, especially for patients with subjective health complaints.

Give and take

The authors point out that long-term sick leave is the shared responsibility of 4 principle stakeholders:

  • GP
  • Employer
  • Social security services
  • Patient

The GPs in this study expressed a need for support and collaboration with the other stakeholders. In practice, however, this may be difficult to achieve. The study concluded that in sick leave negotiations the GPs involved (48, of different ages, sex and from different regions in Norway)

  • Were aware of and apply specific strategies when negotiating sick leave issues with patients with subjective health complaints
  • Try to build an alliance with patients through trying to understand the patient’s situation
  • Focus on trying to have patients return to work as quickly as possible

The authors conclude that the issues involved in sick leave negotiations are complex and further investigation is needed before being able to demonstrate that the current “give and take” strategy described in their article is, in fact, effective.

Read the article:
GPs' negotiation strategies regarding sick leave for subjective health complaints.
Nilsen S, Malterud K, Werner EL, Maeland S, Magnussen LH. Scand J Prim Health Care March 2015