New rules meet established sickness certification practice: a focus-group study on the introduction of functional assessments in Norwegian primary care.

OBJECTIVE: To explore how general practitioners view and handle new standards for functional assessments in sickness certification practice.
DESIGN: Qualitative study using focus group interviews. Data were analysed according to Giorgi's phenomenological approach and supported by theories on knowledge.
SETTING: General practitioners from three neighbouring counties in Norway.
SUBJECTS: Four focus groups with a total of 23 participants were recruited through the Norwegian Medical Association and its Continuous Medical Education system.
RESULTS: The participants reported difficulties and reluctance to act in accordance with new functional assessment demands on both a practical and a conceptual level. In established sickness certification practice functional assessment was described as an unspoken part of the medical examination. After the introduction of formal, written functional assessments they identified problems of terminology, communication, and trust. Strategies were developed to circumvent these problems.
CONCLUSIONS: A gap was noticeable between the participants' established practice and the new standards' demand for a more theoretical and communicative functional assessment. The general lack of training, being confronted with new terminology, and increasingly high pressure to reduce sickness absences create an atmosphere of insecurity when assessing function.