Independent medical evaluation for sick-listed workers in Norway: A focus group study of the experience of IME doctors

Abstract

Background: Norwegian politicians have proposed the use of an independent medical evaluation (IME) as a possible solution for reducing long-term sick leave. The use of an IME implies that a new doctor interferes in the relationship between sick-listed workers and their general practitioner (GP). The aim of the current study was to explore experiences of IME doctors from an ongoing randomized controlled trial (the NIME trial evaluating the effect of IME in Norway). Methods: Two focus group interviews were conducted with eight of the nine IME doctors employed in the NIME trial. The discussions were audio-taped and transcribed. Systematic text condensation was used for analysis. Results: The participants reported that the IME provides important second opinions, which they felt empowered the sick-listed workers and provided new insights into their condition. Beneficial IME working conditions and enhanced insight into different sick leave measures were crucial to this perceived usefulness. Some of the participants expressed disappointment with GPs acting as passive conductors and struggled to provide feedback politely. Some adjustments were proposed as necessary for the IME to be implemented nationwide. Conclusions: The participants seemed to have gained a different stakeholder identity by sometimes seeing GPs, their peers, as obstacles to return to work and welcomed the use of IME on a regular basis.

Keywords

General practice sick leave independent medical evaluation workers’ compensation qualitative research

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References

Organization for Economic Co-operation and Development. Sickness, disability and work: Breaking the barriers. A synthesis of findings across OECD countries. Paris: OECD Publishing, 2010.

Brage

Kann

Fastlegers sykemeldingspraksis I: Variasjoner, www.nav.no/no/NAV+og+samfunn/Kunnskap/Analyser+fra+NAV/NAV+rapportserie/NAV+rapporter/fastlegers-sykmeldingspraksis-i-variasjoner (2006, accessed 22 November 2017).

Husabo

Monstad

Holmås

et al . Protocol for the effect evaluation of independent medical evaluation after six months sick leave: A randomized controlled trial of independent medical evaluation versus treatment as usual in Norway. BMC Public Health 2017;17:573.

Loisel

Durand

Baril

et al . Interorganizational collaboration in occupational rehabilitation: Perceptions of an interdisciplinary rehabilitation team. J Occup Rehabil 2005;15:581–90.

Kilgour

Kosny

McKenzie

et al . Interactions between injured workers and insurers in workers’ compensation systems: A systematic review of qualitative research literature. J Occup Rehabil 2015;25:160–81.

Morgan

(ed.). Focus groups as qualitative research. 2nd ed. Thousand Oaks, CA: Sage, 1997.

Malterud

Systematic text condensation – a strategy for qualitative analysis. Scand J Public Health 2012;40:795–805.

Lipsky

Street-level bureaucracy: Dilemmas of the individual in public services. 30th anniversary expanded edition. 2nd ed. New York: Russel Sage Foundation, 2010.

Malterud

Theory and interpretation in qualitative studies from general practice: Why and how?

Scand J Public Health 2016;44:120–9.

10.

Aamland

Fosse

Ree

et al . Helpful strategies for GPs seeing patients with medically unexplained physical symptoms: a focus group study. Br J Gen Prac 2017;67:e572–e579.

11.

Kaner

Haighton

McAvoy

BR.

‘So much post, so busy with practice—so, no time!’: A telephone survey of general practitioners’ reasons for not participating in postal questionnaire surveys. Br J Gen Pract 1998;48:1067–9.

12.

Aamland

Maeland

[Primary care physicians’ attitudes to and experiences with sick leave and follow-up. A scoping review] [in Danish]. Tidsskr Velferdsforskn 2016;19:148–78.

13.

Richards

Emslie

The ‘doctor’ or the ‘girl from the University’? Considering the influence of professional roles on qualitative interviewing. Fam Pract 2000;17:71–5.

14.

Carlsen

Norheim

OF.

‘Saying no is no easy matter’ a qualitative study of competing concerns in rationing decisions in general practice. BMC Health Serv Res 2005;5:70.

15.

Kosny

Brijnath

Singh

et al . Uncomfortable bedfellows: Employer perspectives on general practitioners’ role in the return-to-work process. Policy Pract Health Safe 2015;13:65–76.

16.

Nilsen

Malterud

What happens when the doctor denies a patient’s request? A qualitative interview study among general practitioners in Norway. Scand J Prim Health Care 2017;35:201–7.

17.

Letrilliart

Barrau

Difficulties with the sickness certification process in general practice and possible solutions: A systematic review. Eur J Gen Pract 2012;18:219–28.

18.

Wynne-Jones

Mallen

Main

et al . What do GPs feel about sickness certification? A systematic search and narrative review. Scand J Prim Health Care 2010;28:67–75.

19.

Haggerty

Reid

Freeman

et al . Continuity of care: A multidisciplinary review. BMJ 2003;327:1219–21.

20.

Mjolstad

Kirkengen

Getz

et al . What do GPs actually know about their patients as persons? Eur J Pers Cent Healthcare 2013;1:149–60.

21.

Ebrahim

Sava

Kunz

et al . Ethics and legalities associated with independent medical evaluations. CMAJ 2014;186:248–9.

22.

Lax

Manetti

Klein

RA.

Medical evaluation of work-related illness: Evaluations by a treating occupational medicine specialist and by independent medical examiners compared. Int J Occup Environ Health 2004;10:1–12.

23.

Kilgour

Kosny

Akkermans

et al . Procedural justice and the use of independent medical evaluations in workers’ compensation. Psychol Inj Law 2015;8:153–68.

24.

Lippel

Preserving workers’ dignity in workers’ compensation systems: An international perspective. Am J Ind Med 2012;55:519–36.

25.

Everett

Faber

Crockett

Preferences and beliefs in ingroup favoritism. Front Behav Neurosci 2015;9:15.

26.

Maiwald

de Rijk

Guzman

et al . Evaluation of a workplace disability prevention intervention in Canada: Examining differing perceptions of stakeholders. J Occup Rehabil 2011;21:179–89.

27.

Seing

Ståhl

Nordenfelt

et al . Policy and practice of work ability: A negotiation of responsibility in organizing return to work. J Occup Rehabil 2012;22:553–64.