Medicine in the Community: Work and Health

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Medicine in the CommunityWork and Health

• Dr. Debbie Cohen
• Senior Medical Research Fellow
• Cardiff University

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Overview

• Evidence around work and health
• A typical scenario
• Managing the fitness for work consultation

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Common health problems

• Limited objective evidence of disease
• Largely subjective complaints
• Often associated psychosocial issues

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Common Health Problems

• CHP form approximately 75 of all sickness
  absence and IB
• Less severe mental health disorders
• Musculoskeletal disorders
• Cardio respiratory disorders

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IB Recipients - Diagnoses
Incapacity-related benefit recipients by
diagnosis group, November 2003
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Evidence

• Common Mental Health Conditions
• 1 in 4 people of working age develop some kind of
  mental health problem
• 35 40 of work related health problems,
  sickness absence long term incapacity and early
  retirement

Waddell and Burton
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Is work good for your health and wellbeing?

• Overall beneficial effects of work outweigh the
  risks
• Worklessness is associated with poorer physical
  and mental health and well being
• Work can be therapeutic and can reverse the
  adverse health effects

Waddell and Burton
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The provisos

• Good job- nature of the job
• Social context - Regional deprivation
• Overall beneficial effects of work outweigh
  the risks

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Timing of Interventions

• The longer a patient is off work with pain, the
  greater the risk of developing chronic pain and
  disability and the less likely they are to ever
  return to work
• By six weeks off work the there is a 10- 40
  chance that they will still be off work at one
  year
• By six to twelve months off work there is a 90
  chance that of never returning to any form of
  work in the foreseeable future.

Waddell, Aylward and Sawney (2002)
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Risks and Harm of being out of work

• Loss of fitness
• Physical and mental deterioration
• x2-3 risk of poor health
• Psychological distress and depression
• Increased x2-3
• Increased suicide and mortality
• 20 excess deaths
• Social exclusion
• Poverty

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Facts about people being out of work

• Has the equivalent impact as smoking 10 packs of
  cigarettes per week (Ross 1995)
• Suicide in young men who have been out of work
  for more than 6 months is increased by 40 times
  (Wessely, 2004)
• Suicide rate in general is increased by 6 times
  in longer-term worklessness (Bartley et al, 2005)
• The risk of being out of work in the longer term
  is greater than the risk of other killer diseases
  such as coronary heart disease (Waddell
  Aylward, 2005)

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Why do some people not recover as expected?

• Bio-psycho-social factors may aggravate and
  perpetuate disability
• They may also act as obstacles to recovery
  barriers to return to work

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The Biopsychosocial Model

• Biological factors
• Psychological factors
• Social factors

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The personal dimension of incapacity

• The personal experience of illness disability
• Attitudes and beliefs, emotions, coping abilities
  strategies
• Perceptions expectations
• Motivation effort

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Social barriers

• the culture that surrounds health, sickness,
  disability and work
• labour market forces
• social and occupational barriers
• discrimination, social disadvantage and social
  exclusion
• financial (dis)incentives

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Biopsychosocial Model
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Shifting attitudes to health work
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The consultation

Initiating the Session Gathering
Information Physical Examination Explanation
Planning Closing the session
Building the Relationship
Providing Structure
J. Silverman
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Take a closer look

• NOTE TO TRAINERS
• Add in here either a video of a fitness for work
  consultation or provide the students with a
  written scenario or role play a scenario

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The Biopsychosocial Model

• Biological factors
• Psychological factors
• Social factors

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Management Plan

• Biological

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Management Plan

• Biological
• Flags
• Mobility
• Pain relief
• Rehabilitation Exercise/physio

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Management Plan

• Psychological
• Length of absence

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Management Plan

• Social
• Personal factors
• Family
• Work
• Economic factors

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Management Plan

• Certification
• What are the
• options?
• What else could
• you do?

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Management Plan

• Put the patient centre stage
• Manage expectations
• Rehabilitation must be integrated into-
  clinical management- occupational management

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Work and Health
Dr. Debbie Cohen Cardiff University