van Rijssen et al. BMC Public Health 2010, 10:666 http://www.biomedcentral.com/1471-2458/10/666 Subsequently, when the physician meets the claimant for the first time, the sight of the person in the waiting room, their way of shaking hands, and other non-verbal signals also influence the physician’s impression of the claimant. The physicians stated that these first impres- sions are useful, because they only have approximately half a minute to decide on how to approach the clai- mant. Furthermore, they also use first impressions “as a diagnostic tool. If you think that someone is compulsive or manic - for example people who won’t stop talking - you ask other questions to test that presumption”. Advantages and disadvantages of stereotyping Although stereotyping has its disadvantages, according to the social insurance physicians in the focus group meetings, the information it provides can also be useful. For the physicians the main advantages of having a mental picture of what claimants will be like, before meeting them, were: (1) it provides a framework for the assessment interview; (2) it can save time; and (3) it is interesting to check whether the classification is correct. Firstly, a practical advantage was that stereotypes pro- vide a framework for the assessment interview, which means that the physician can prepare more thoroughly and has less reason to feel insecure: “I want to prepare well, I want to be able to assess to some degree what I might run into. And that people know that I have pre- pared”. The physician can anticipate the effort that must be made to gather information, the eagerness of the clai- mant to oppose or to irritate the physician (including possible hidden agendas), and the likelihood that the claimant will file a complaint. Moreover, stereotypes provide the physician with a theory to test the claimant and the claimant’s disabilities, and the physician can use the stereotype for diagnostic purposes. Secondly, stereotyping has the practical advantage that it can help to save time. All the physicians thought that this was important: “Saving time is important given our circumstances ... We need a lot of information in a short time. We run into time limitations.” (female, 41 years old, social insurance physician for 14 years) Stereotyping claimants can shorten the interview, because the focus of the interview can be determined beforehand, and more effective preparation saves time. For example, collecting information about the disability of the claimant can accelerate the interview and prevent unnecessary sidetracking, and inferences concerning the cultural background of claimants may increase under- standing of their disabilities: “The ultimate goal is gath- ering information within an hour. And than, you have to - with the help of the techniques you know - get that Page 8 of 13 information clear. And depending on the different groups you will have to adjust”. However, when physi- cians classify the claimant wrongly, the interview will probably take more time, instead of less. Thirdly, some physicians argued that it is rewarding to find out whether their stereotypes are correct. They form an opinion of the claimant, and test this hypothesis for its accuracy: “A little ‘professional curiosity’ ... I can amuse myself with that”. Usually, the stereotype is con- firmed or rejected. Especially when the reality is exactly the opposite of the expectations, this can motivate the physician to be more cautious and accurate next time, and keeps it interesting. One of the physicians explained this as follows: “Beforehand you create an image, and sometimes also real prejudices ... Then I enjoy being confronted with these, and I think: it’s going to be a dif- ficult interview ... Then afterwards I could have kicked myself and my prejudices, nothing about a human being is foreign to me. Yeah, that’s fun”. As stated before, stereotypes often prove to be incor- rect, and expectations often remain unmet. This is one of the disadvantages of stereotyping that was mentioned by the physicians. The two other disadvantages they mentioned, are: a stereotype does not give the complete picture, and because people are dynamic constant adjustment is needed anyway. Firstly, the fact that stereotypes often prove to be incorrect and expectations often remain unmet is illu- strated by these citations: “At the same time, that’s the weakness, because you never know” and “You think: oh, it will be one of those people. At that moment ... it’s quite different from what you had expected”. The physi- cians emphasised that it is important to stay as free from value judgements as possible. This is also to pre- vent unnecessary worrying beforehand, and to prevent an unpleasant atmosphere during the interview. More- over, stereotyping might cause the physician to miss cer- tain information. Secondly, the physicians argued that a stereotype does not give them the complete picture; there is much more that should be taken into account, and “classifying in types is one aspect, but you can’t base an entire interview on that”. The situation (e.g. why a claimant is on sick leave), environment, social network, and intelligence of the claimant are also important, just like the physician’s characteristics and the dynamics of the physician-clai- mant contact. Moreover, the moment at which the inter- view takes place is also important: “And that defines standards and values. Then you can have a person with many substantial symptoms of rheumatism and several adaptations, and he’s willing to work, and another person who barely has any disability and ... then you think ‘what a whiner’ - but you don’t say it - compared to the other person [with many substantial disabilities]. Things like