van Rijssen et al. BMC Public Health 2010, 10:666 http://www.biomedcentral.com/1471-2458/10/666 Page 5 of 13 Figure 1 A typology of claimants reported by physicians which forms the basis for stereotypes based on the interpersonal circumplex. (more details of each of the categories are provided in Table 2). lower left quadrant in Figure 1): claimants take a sub- missive position in interacting with the physician. These claimants make the interview time-consuming or rather difficult. One physician characterised claimants who passively cope with their disabilities as: “The person who sees problems everywhere. Who thinks of 10 problems for every solution you suggest. Also, 10 solutions to every problem but, according to them, they are all no good.” (female, 34 years old, social insurance physician for 5 years) Another physician confirmed the problems of lack of motivation in the interview: “They don’t know, so they go along completely with my story, but that’s not what I want. I want informa- tion, but that’s not what I get. When I facilitate the conversation, I just fill in the blanks according to my own ideas, but I already know those. I’m interested in what they do, but they don’t say anything. They give you the feeling that, no matter how hard you work, you will never get where you want to be. And then you work really hard, but that doesn’t help either.” (male, 51 years old, social insurance physi- cian for 22 years) The physicians stated that passively coping with dis- abilities might be due to a different cultural background, because in the Dutch social security benefits system a person is held responsible for his/her own behaviour and its consequences. They argued that people with a different cultural background take one day at a time, do not take personal responsibility, and are not expected to have any control over their life. This creates barriers “because you try speaking in Dutch, or you try to explain the consequences of the Dutch law to such a person, but they can’t understand, because it doesn’t fit in with their culture”. The physicians found it difficult to asses claimants with a mental diagnosis or an unclear ‘physical’ diagnosis: “You actively have to search for what exactly is going on. Of course, we’re talking about those syn- dromes for which it has already been said that they’re vague, they’re non-specific. Certainly, with those syndromes I’m always suspicious, and wonder what else could be the matter?” (male, 48 years old, social insurance physician for 27 years)