Why are general practitioners reluctant to enrol patients into a RCT on sick leave? A qualitative study

To explore the reluctance of, and examine the arguments given by Norwegian general practioners (GPs), regarding their unwillingness to recruit their patients for a study where sick leave would be based on randomization.

A qualitative study presenting individual arguments from 50 Norwegian GPs, as written responses to a web-based, open-ended questionnaire. The responses, ranging from 3-145 words, were analysed with systematic text condensation.

The GPs did not want to participate in a study where sick leave was decided by randomization. First, the complexity of clinical judgment was addressed. Would it be ethically acceptable to set the professional and medical assessment aside, and if so, was there any better judge than the regular GP in making this important decision? Second, the arguments dealing with sick leave as a human and legal right were addressed. Will patients feel they have a legitimate right to sick leave and will they be open for discussion with their GP? Third, the risk of jeopardizing the relationship between patient and doctor was emphasized. Would the patients be able to trust their GP if he or she offered the patient entry into a trial where sick leave would be decided by randomization?

Randomization of sick leave in general practice in Norway was not viewed as feasible by the GPs themselves because of the importance of clinical judgment, ethical obligations, and the belief that the patients would refuse participation, and thereby, that the doctor-patient relationship would be disturbed.