How GPs in Norway conceptualise functional ability: a focus group study

Abstract

Loss of functional ability has been introduced as a criterion for social benefits in several European countries. This criterion may direct attention towards work ability and individual resources, and thus reduce the number of persons claiming social benefits. However, little is known about how functional ability is conceptualised by GPs. To explore how GPs conceptualise functioning and functional ability in relation to their sickness certification practice. Qualitative study using focus group interviews. General practices in Eastern Norway. Four focus groups with a total of 23 GPs were recruited via the Norwegian Medical Association. Data were analysed according to Malterud's systematic text condensation method and supported by a historical framework. Functioning was conceptualised by the GPs as physical, mental, and social ability. Of these domains, physical ability received special emphasis in the conceptualisation of overall functioning. The assessment of physical functioning was generally considered straightforward, aside from instances in which the underlying pathology proved difficult to locate. Mental ability was reportedly more difficult to assess, and the GPs used a wide array of rating scales to support assessments. Social ability was described in terms of social problems and their impact on patients' general functional ability. Relating functional ability to patients' work situation was a two-step process requiring knowledge beyond the scope of the clinician. The concept of functioning is understood within a biopsychosocial paradigm, but implementing it into clinical practice and in accordance with insurance legislation proves difficult.