Literal Tricks of the Trade. The Possibilities and Contradictions of Swedish Physicians’ Everyday Resistance in the Sickness Certification Process

This article deals with the ways Swedish General practitioners (GPs) informally deal with the stricter standards of sickness certification and the implications of understanding these ways in terms of ‘resistance.’ In recent decades, procedural and bureaucratic changes within the Swedish sickness benefit system have curtailed physicians’ clinical discretion with regards to the sickness benefit approval for patients. By both formal and informal means, the Swedish Social Insurance Agency (SSIA) has consolidated its power over the decision-making process. Despite widespread dissatisfaction among physicians with the current system, acts of open defiance do not seem to occur. However, as shown in a recent qualitative study, Swedish General practitioners have developed informal ‘techniques’ (ranging from simple exaggerations in the certificates to complex constructions of apparent objectivity) for intentionally circumventing the stricter sickness certification standards. Taking that study as a point of departure, this article will consider the use of techniques as a form of everyday resistance. Three dimensions of ambiguity arise which require further attention, namely: (1) the multiple motives and shifting target of resistance; (2) the complex blend of power and powerlessness which defines the situation of GPs and their resistance, and (3) the fundamental ambiguity of the resistant act of issuing sickness certificates tactically, as a particular mix of compliance and resistance.