Authorization to Disclose: How Occupational Physicians Interpret Confidentiality in Return-to-Work Negotiations

To analyze occupational physicians' (OPs) interpretations of confidentiality regarding health information in multistakeholder return-to-work (RTW) negotiations, situated at the intersection of healthcare and working life.

Reflexive thematic analysis was applied to 14 video-recorded RTW negotiations and 14 interviews with OPs involved in these negotiations.

Four themes were developed, showing how OPs navigate confidentiality by (i) addressing knowledge asymmetries among participants, (ii) balancing their dual role in fostering trust, (iii) constructing confidentiality as depending on employees' willingness to disclose health information, and (iv) approaching confidentiality flexibly to find solutions for RTW. Interpretations varied across and within negotiations, depending on specific situations or negotiation objectives.

Our study reveals that OPs' aim at restricting discussions on employees' health and respect their autonomy in disclosing health information in RTW negotiations, yet their approach to confidentiality seems complex and situationally flexible. Confidentiality issues compete with other incentives and complicate the collaboration, thus careful attention, ethical considerations, and clearer guidance from policymakers are required. The demanding nature of planning and leading RTW negotiations calls for systematic education of interaction skills in OPs' specialist training. Further research is needed to explore the strategies and meaning-making related to confidentiality in multistakeholder RTW collaboration.