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

在过去几年中，由于精神疾病而暂时丧失工作能力和提前退休的人数在增加。躯体疾病只有这种影响的一半。证明由于医疗原因暂时无法工作，首先是对病人的一种救济。然而，从长远来看，它阻碍了重新进入职业生活，从而破坏了社会状况的稳定，因为有酬职业与社会融合密切相关。尤其是，对受影响者的相关污名化阻碍了他们的职业回归。主要目标是找出全科医生如何处理这种冲突。一方面，他们必须遵循他们对治疗和愈合的专业理解。另一方面，他们必须在特定的社会医疗系统中做出可能与他们的专业理念相矛盾的决定。本项目探讨了全科医生如何解释和实施他们的专业自主权，同时引入他们的科学和解释能力。采用叙事，半结构化和开放式访谈技术的项目研究全科医生如何处理他们的矛盾的做法之间的考虑特定情况和系统的必要性。通过获得的情况下小插曲的结果将是一个类型的全科医生的矛盾的专业实践。本研究有助于全科医生在社会微观和宏观层面的相互作用中的特定自我概念和实践的专业具体化理论。这项研究的一个重要贡献将是讨论在精神疾病病例中以病人为中心的护理供应不足和供应过剩以及分配不当的问题。

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.