Acting by Persuasion; Values and Rhetoric in Medical Certificates of Work Incapacity; A Qualitative Document Analysis

by Guri Aarseth

When acting as experts for the Norwegian National Insurance Administration (NAV), should the GP first and foremost consider the interest of his/her patient, his/her own professional integrity or the interest of society? Values are present in nearly all texts; a legitimate medical certificate is supposed to be ‘neutral, professional and objective’ – which is also a value choice.

We have studied a number of medical certificates of work disability written by GPs, asking: which values are promoted and what attitudes (feelings, judgements and appreciations) are mediated by the GPs in these certificates?

When arguing for disability benefit (they all did), the GPs seemed to be little concerned about the formal criteria of benefit, such as diagnoses and diseases. Rather, they emphasised the patients’ positive character (sincerity, perseverance, tenacity and sacrifice) and attitudes (being motivated for work, a willingness to contribute to one’s recovery and participate in work training), indicating that they were not malingerers, but worthy applicants who ‘deserved’ disability benefit.They argued that disasbility benefit would improve life quality (for instance, help ending their drug abuse) or that granting them benefit (after years of training and waiting) would be a pragmatic and realistic decision. They appealed to the reader’s sympathy, understanding and compassion, probably intending to share responsibility with the certifier.

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