Case versus system: professional self-concept and logics of action of general practitioners in the context of attesting temporary incapacity to work due to mental illness

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In the last couple of years temporary incapacity to work and early retirement due to mental illness are on the rise. Somatic diseases have only half of this effect. The attestation of a temporary incapacity to work due to medical reasons is at first a relief to the patient. In the long run, however, it hampers the re-entry into the professional life and thereby destabilises the social situation as gainful occupation is significantly related to social integration. Not least, the related stigmatisation of the affected impedes their professional comeback. The main goal is to find out how general practitioners deal with this conflict. On one hand, they have to follow their professional understanding of treatment and healing. On the other, they have to make decisions in a specific social health care system that migth contradict their professional ideas.This project investigates how general practitioners interpret and carry out their professional autonomy while bringing in their scientific and hermeneutic competences. Employing narrative, semi-structured and open interview techniques the project researches how general practitioners deal with their paradoxic practice between the consideration of the particular case and systemic necessities. By obtaining case vignettes the outcome will be a typology of general practitioners' paradoxic professional practice. The study contributes to the theory of professional concretion of the specific self-concept and practice of general practitioners in the interplay between societal micro and macro levels. An important contribution of the study will be the discussion of the under- and over-supply, as well as misallocation of patient-centred care in cases of mental illness.