The NIME trial forced extra work on the GPs through reassuring assigned patients and writing of resumes. A recent study exploring the sick-listed patients’ perspectives, reports the importance of GPs spending time and effort on these tasks [
16]. Our participants had positive attitudes towards receiving second opinions as they acknowledged possible medical blind spots or lack of insight into useful sick-leave measures. This is consistent with previous research showing that GPs lack insight into important resources and/or measures in the RTW processes [
21,
22], and is also in line with Lipsky’s theory that street-level-bureaucrats may lack knowledge in order to respond properly to individual cases [
19]. Nevertheless, one of our main findings showed that the participants did not find the IME-reports useful, which is contrasting the IME-doctors own view of contributing with constructive second opinions [
17]. For example, the participants expressed skepticism towards suggestions of referrals to a psychologist and noted a number of plausible reasons for this skepticism. This response may also be an example of lack of knowledge due to lack of time resources [
19] to stay updated, particularly since the positive effect of cognitive behavioral interventions on RTW is well documented among patients with common mental disorders [
23] and for patients experiencing long-term and functionally disabling unexplained symptoms [
24]. On the other hand, receiving advice on a patient that they did not find challenging may explain the low perceived utility of the IME report. It appeared that our participants would have higher trust in IMEs if they could select particularly challenging sick-listed patients for a mandatory IME. In a Norwegian study aiming to lower sick-leave rate, the GPs picked complex sick-listed cases to discuss with senior insurance physicians. Yet, this study found that such supervision did not result in a decreased sick-leave rate, although the participating GPs expressed great satisfaction with the intervention [
25]. Finally, our participants emphasized the importance of IME-doctors being GPs. Our participants trusted experienced peers (i.e. the IME doctors in the NIME trial) to be the most suitable doctors to perform IMEs. Findings from Australia support this as GPs [
26] and psychologists [
27] reported negatively to IMEs being performed by professionals who lacked experience and skills to evaluate the reasons for the patients’ sickness absence. Both our and the Australian findings may however raise an issue that is central in IME internationally: can doctors/health professionals accept a contrasting assessment by another health professional, essentially interfering in a long-established doctor-patient relationship? Previous research has shown that GPs struggle to accept it when the welfare administration overrules their sick-leave recommendations [
28].