Sammendrag av avhandlingen:
The project studies Norwegian GPs' use of language in 33 medical certificates of work disability written for the National Insurance Administration (NAV).
The study is a qualitative document analysis using narratological and linguistic approaches. We investigated a) how the documents depict the patient as a person and participant, b) how they construe connections between illness and work disability and c) the values and attitudes emerging in the certificates.
Main results:
The texts were mainly symptom-oriented, not patient-oriented. The certifiers largely construed the patients as passive objects. Symptoms were foregrounded as independent and powerful actors, whereas the patients' agency was generally low, failed or non-existent.
Some of the medical information was unclear, ambiguous, and sometimes possibly misleading. The bases of working incapacity were mostly vague.
Even when the GPs sometimes had doubts about the claimants’ working ability, they supported granting them disability benefit. By describing patients in terms of positive social esteem, e.g., their positive attitude toward working, they construed them as worthy or "deserving claimants" while patients associated with lower social regard (e. g drug abuse) would have their quality of life improved by having benefits. Emotions attributed to the patients were such as stress, anxiety, and uncertainty and they were associated with their negative experiences with the NAV (not being believed or prolonged processing time).
Implications:
This dissertation suggests that the GP's' certifying task should be limited to providing medical information. Also, it suggests introducing the claimant's self-representation as a separate and legitimate part of the certificate. This would bring up to date the patient's role as a subject and a a real participant in his/her process.