van Rijssen et al. BMC Public Health 2010, 10:666 http://www.biomedcentral.com/1471-2458/10/666 Background Generalising and categorising is necessary to make sense of the complex behaviour of other people. It makes it easier to form coherent impressions of others, and also to understand them. It is, in fact, impossible to start commu- nicating with a stranger without making inferences about that person based on general experiences, and thus stereo- typing [1]. The application of general ideas and beliefs about groups of people to individuals is known as stereo- typing. Stereotyping increases comprehension, because of its informative value. For example, it enables people to make an educated guess about aspects for which no actual information is available [2,3]. However, stereotyping is also associated with several problems, such as excluding indivi- duals or discriminating them based on prejudices towards groups of people, collective treatment which puts people in an inferior position, and behaviour towards others which leads to stereotype confirmation. Therefore, indivi- dual information is generally preferred over stereotyping [2,4,5]. Stereotypes may be applied and discarded during an encounter, but whether or not they are applied in con- tact with other people depends on many factors, for exam- ple on cognitive resources, motivation, and goals [2,6]. Stereotypes may be applied to make communication easier in an initial contact [2]. Studies have indicated that mechanisms of stereotyping can affect a physician’s treatment-related decision-mak- ing [7], because stereotyping can affect the interpretation of behaviour, symptoms, and diagnosis of patients. Stereotyping can also affect the physician’s communica- tion style [7], the physician’s behaviour towards the patient [8,9], the patient’s motivation and treatment adherence [5,9], and the health care provided [5]. Furthermore, research has convincingly shown that there is no truth in the general belief that physicians are objec- tive and neutral. For example, the demographic charac- teristics of a patient, such as age, ethnicity, gender, and socioeconomic status, have been found to influence the beliefs and expectations of physicians, especially when complicated assessments, incomplete information, incor- rect information, or time-pressure are involved [10,11]. Stereotypes also influence the interpretation of clinical findings, for example because physicians provide inferior care to some groups of patients, due to stereotyping [10]. Social insurance physicians meet their patients (clai- mants) during the medical disability assessment inter- view to determine their entitlement to social security benefits. Given the earlier-mentioned research results, these assessments will probably be influenced by the physicians’ stereotyping, and especially because one-time contacts are common, claimants will not always be inclined to give correct information, and many claimants have to be assessed in a limited period of time (i.e. Page 2 of 13 approximately one hour per claimant). However, little is known about the mechanisms of the reasoning of physi- cians during clinical and diagnostic decision-making [12,13]. Moreover, stereotyping is more likely to result when differences in status and power exist between peo- ple [9,14], and those differences obviously exist between physicians and their patients during disability assess- ments. This is especially relevant, because a lot is at stake for the claimants. Yet, very little is known about stereotyping by social insurance physicians, about their handling of information confirming or disconfirming the stereotyping, and about the influences of stereotyping on medical disability assessment interviews. Previously, our research group has described the con- ceptualisation of a behavioural model regarding the communication between social insurance physicians and their claimants [15]. This model describes physician- claimant communication from a distance. However, as an actor within the model, one cannot directly observe the other person’s intentions and attitudes. Studying the physician-observed determinants of the communication behaviour of claimants, will increase insight into how physicians evaluate claimants and communication beha- viour of claimants. This might help to further develop the model and assist its applicability in education for physicians (i.e. the communication skills training course that we are developing for social insurance physicians). Medical disability assessments are sometimes criticised by Dutch society for not taking the unique disabilities of particular claimants into account. These critiques are best illustrated by remarks from claimants in our prior questionnaire study among 63 claimants [16]. One clai- mant, for example, said that “she [the social insurance physician] seemed to observe only information that sup- ported her preconceived notions” and another claimant noted: “The physician clearly had his judgement ready, which contradicted the judgement of my occupational physician, internist, and therapist”. Of course, these quotes represent the view of the claimant, which may differ from ‘reality’, and these situations may not occur very often, but this has never been studied. Therefore, the aim of this paper was to investigate: (1) the content of stereotypes used to classify claimants with regard to the way in which they communicate; (2) the origins of such stereotypes; (3) the advantages and disadvantages of stereotyping in assessment interviews; and (4) how social insurance physicians minimise the undesirable influences of negative stereotyping. Methods Data-collection and subjects Data were collected in focus group meetings planned during the regular monthly meetings of groups of social