Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association

Just Accepted

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Distrusting doctors’ evidence: A qualitative study of disability income support policy-makers in Australia and Ontario

Ashley McAllister , Stephen Leeder


Objective Describe how policy-makers (bureaucrats and politicians) in Australia and Ontario perceive evidence provided by doctors to substantiate applications for disability income support (DIS) by their patients with mental illness. Because many mental illnesses, (e.g. depression) lack diagnostic tests, their existence and effects are more difficult to demonstrate than most somatic illnesses. Methods Semi-structured interviews were conducted with 45 informants, all influential in the design of the assessment of DIS programs. The informants were sub-categorised into advocates, legal representatives, doctors (general practitioners [GPs] and specialists [e.g. psychiatrists]), policy-makers and researchers. They were found through snowball sampling. Following the principles of grounded theory, data collection and analysis occurred in tandem. Results Informants expressed some skepticism about doctors’ evidence. Respondents perceived that doctors could, due to lack of diagnostic certainty, “write these things (evidence) however you want to”. Psychiatrists, perceived as having more time and skills, were considered as providing more trustworthy evidence than GPs. Conclusion Doctors, providing evidence to support applications play an important role in determining disability. However, policy-makers perceive doctors’ evidence about mental illnesses as less trustworthy than evidence about somatic illnesses. This influences decisions by government adjudicators.

AH16092  Accepted 28 March 2017

© CSIRO 2017