Healer or gatekeeper? : physicians' role conflict when symptoms are non-verifiable

Although physicians are often expected to be gatekeepers to health insurance benefits such as paid sick leave, research indicates a substantial reluctance to reject patient requests for sickness certificates. We show that private information on the patient's part creates a conflict between the healer and gatekeeper roles: if a patient reports subjective symptoms indicating a need for sick leave, the physician is unable to tell if the patient is truly sick or a shirker. We show that even if most physicians prefer to be good gatekeepers, all of them may trust their patients in Nash equilibrium. These ideas are illustrated using results from focus group interviews with Norwegian primary care physicians.