Rhetorical work and medical authority: Constructing convincing cases in insurance medicine

• Published in: Social science & medicine (1982) 2020-11, Vol.264, p.113324-113324, Article 113324
• Main Author: Rasmussen, Erik Børve
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Focus Groups; General Practitioners; Humans; Insurance; Insurance medicine; Interview study; Medically unexplained symptoms; Norway; Physician-Patient Relations; Rhetorical work; Subjective complaints
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2020.113324

This article explores general practitioners' (GPs) persuasive efforts in cases where biomedical evidence is absent but expected. Health insurance in Western countries is based on the biomedical ideal that legitimate complaints should have objective causes detectable by medical examination. For GPs responsible for assessing sickness and incapacity for work, the demand for objective evidence can be problematic: what if they as experts deem that a patient is in fact sick and eligible for benefits, but are unable to provide objective evidence to that fact? How can they convince bureaucrats in the insurance system to accept their judgment? Taking ‘medically unexplained symptoms’ as my case, I draw on focus group and follow-up interviews with GPs in Norway to explore how GPs attempt to persuade bureaucrats to accept their professional judgment. Proposing the concept of ‘rhetorical work’, I reconstruct a typology of such work that doctors engage in to influence bureaucratic decision-making and provide long-term health benefits for patients. I then discuss the potential societal implications of GPs' rhetorical practices and the applications of the concept of rhetorical work in future research. •Absent but expected biomedical evidence cause problems of trust and credibility.•General practitioners (GPs) face such problems as gatekeepers in health insurance.•The study explores GPs' work to construct convincing cases for insurance benefits.•Uses focus groups and follow-up interviews to unpack GPs' persuasive efforts.•Proposes rhetorical work and insurance trajectories as conceptual innovations.