Legitimizing incapacity: discursive choices in Norwegian sickness certificates

Area of Science:

• Medical sociology
• Health communication
• Discourse analysis

Background:

• General Practitioners (GPs) in Norway issue sickness certificates (SCs) to document work incapacity.
• SCs influence non-medical stakeholders' perception of patient work capacity.
• This study analyzes SC language in constructing narratives of work ability.

Purpose of the Study:

• To examine how sickness certificate language portrays patient limitations and recovery prospects.
• To understand the discursive construction of work ability in SCs.
• To identify linguistic features impacting non-medical stakeholder interpretation.

Main Methods:

• Qualitative discourse analysis of 155 SCs from Norwegian GPs.
• Focus on patients under 35 with common mental health conditions.
• Analysis of certificates issued around week 39 of sick leave.

Main Results:

• SCs predominantly used definitive language to emphasize incapacity and work absence.
• Recovery potential was described tentatively, with treatment timelines acting as barriers.
• Specialized terminology and elliptical constructions burdened non-medical readers; recommendations for accommodations were scarce.

Conclusions:

• Administrative pressures and dual GP roles shape SCs, often reinforcing incapacity narratives.
• Enhancing SCs via structural changes and interdisciplinary collaboration can improve assessments.
• Positioning SCs as collaborative tools may foster shared accountability for return-to-work efforts.