title: GPs' negotiation strategies regarding sick leave for subjective health complaints.
abstract: OBJECTIVE
  To explore general practitioners' (GPs') specific negotiation strategies regarding sick-leave issues with patients suffering from subjective health complaints.
  
  
  METHODS
  Focus-group study.
  
  
  METHODS
  Nine focus-group interviews in three cities in different regions of Norway.
  
  
  METHODS
  48 GPs (31 men, 17 women; age 32-65), participating in a course dealing with diagnostic practice and assessment of sickness certificates related to patients with subjective health complaints.
  
  
  RESULTS
  The GPs identified some specific strategies that they claimed to apply when dealing with the question of sick leave for patients with 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 effects of 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
  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 doctor and patients in these complex encounters is needed.
authors.affiliation: Research Unit for General Practice, Uni Research Health , Bergen , Norway.
authors.forename: Stein
authors.initials: S
authors.lastname: Nilsen
authors.forename: Kirsti
authors.initials: K
authors.lastname: Malterud
authors.forename: Erik L
authors.initials: EL
authors.lastname: Werner
authors.forename: Silje
authors.initials: S
authors.lastname: Maeland
authors.forename: Liv Heide
authors.initials: LH
authors.lastname: Magnussen
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005194:Family Practice; D005260:Female; D017144:Focus Groups; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D017008:Negotiating; D009664:Norway; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D062707:Return to Work; D018582:Sick Leave
keywords: Family practice; Norway; focus groups; general practice; health communication; negotiating; return to work; sick leave