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The construction of ethnic differences in work incapacity risks: Analysing ordering practices of physicians in the Netherlands

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  • Meershoek, Agnes
  • Krumeich, Anja
  • Vos, Rein

Abstract

Drawing from Science and Technology Studies we investigate the consequences for social differentiation of physicians' practices in Dutch illness certification. Using participant observation methods, we followed six 'Arbodienst' physicians for two weeks each. Our analysis explores whether and how the work of Dutch physicians contributes to the appearance of a category of 'problematic migrant patients'. We present how physicians, in using instruments to distinguish plausible from implausible claims for sick leave, impose order upon reality. In particular situations this ordering involves a distinction between Dutch and migrant clients. Here ethnicity appears in physicians' practice as a separate instrument to constitute order, which in the case of migrants overrules the productive instruments that are used for 'Dutch' clients. By interpreting clients' behaviour in cultural terms and making them into strangers, physicians lose their ability to fine-tune their coaching activities to the needs of these clients. As a result migrants remain work incapacitated for a longer period, which leads to a higher risk of their ending up in the disability pension program. As a consequence migrants become visible as a problematic group in the data on work incapacity and disability. The practice to categorise migrant clients with separate instruments thus results in a 'hard' category of problematic migrant clients and leads to social differentiation.

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  • Meershoek, Agnes & Krumeich, Anja & Vos, Rein, 2011. "The construction of ethnic differences in work incapacity risks: Analysing ordering practices of physicians in the Netherlands," Social Science & Medicine, Elsevier, vol. 72(1), pages 15-22, January.
  • Handle: RePEc:eee:socmed:v:72:y:2011:i:1:p:15-22
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    References listed on IDEAS

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    1. Aronowitz, Robert, 2008. "Framing disease: An underappreciated mechanism for the social patterning of health," Social Science & Medicine, Elsevier, vol. 67(1), pages 1-9, July.
    2. Johnston, Meghan E. & Herzig, Rebecca M., 2006. "The interpretation of "culture": Diverging perspectives on medical provision in rural Montana," Social Science & Medicine, Elsevier, vol. 63(9), pages 2500-2511, November.
    3. Aronowitz, Robert, 2008. "Rejoinder to commentaries on "Framing disease: an underappreciated mechanism for the social patterning of health"," Social Science & Medicine, Elsevier, vol. 67(1), pages 20-22, July.
    4. Meeuwesen, Ludwien & Harmsen, Johannes A.M. & Bernsen, Roos M.D. & Bruijnzeels, Marc A., 2006. "Do Dutch doctors communicate differently with immigrant patients than with Dutch patients?," Social Science & Medicine, Elsevier, vol. 63(9), pages 2407-2417, November.
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    1. van Hal, Lineke & Meershoek, Agnes & Nijhuis, Frans & Horstman, Klasien, 2013. "Disembodied abilities: Sick role and participation in ‘activating’ return-to-work practices," Social Science & Medicine, Elsevier, vol. 96(C), pages 9-16.
    2. Thomas Niederkrotenthaler & Petter Tinghög & Sidra Goldman-Mellor & Holly C Wilcox & Madelyn Gould & Ellenor Mittendorfer-Rutz, 2016. "Medical and Social Determinants of Subsequent Labour Market Marginalization in Young Hospitalized Suicide Attempters," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-15, January.
    3. Proctor, Alana & Krumeich, Anja & Meershoek, Agnes, 2011. "Making a difference: The construction of ethnicity in HIV and STI epidemiological research by the Dutch National Institute for Public Health and the Environment (RIVM)," Social Science & Medicine, Elsevier, vol. 72(11), pages 1838-1845, June.

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