Is your patient fit for work

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Is your patient fit for work? Part 1
Stakeholders and standards
Grant McMillan Hon Senior Clinical Lecturer
Institute of Occupational and Environmental
Health University of Birmingham Number 9 of a
series of lectures and tutorials for medical
undergraduates
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HEALTH gtgtgtgt WORK gtgtgtgt HEALTH
To ignore the two way interactions between work
and health is to risk misdiagnosis,
mismanagement and overall failure to do your best
for your patients and society at large.
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Learning points

• Stakeholders, assumptions and expectations
• Complexity of absence role of health
  professional
• Usefulness of task-related health and fitness
  standards in matching people to employment
• Importance of ensuring that the patient and you
  agree that return to work is a planned outcome of
  treatment

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Stakeholders in workers health

• Individual workers
• Community of workers
• Workers families
• Employers and shareholders
• Government and society
• Health professionals

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Ground rules All stakeholders benefit from
employees being fit and healthy. Employees need
not be entirely fit and healthy for all
stakeholders to benefit.
Employees who are not entirely fit and healthy
may still be employable. Employability may be
enhanced by altering the work and/or workplace.
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Absence is complex - not just about a health
problem

• It is vital to have the right people
• dealing with the right issues
• Health related - assessment of fitness for role
• Social/domestic such as debt, childcare, divorce
• Work-related manager/employee relationships
• Reasonable adjustment of work and rehabilitation

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Stakeholders in workers health

• Individual workers
• Community of workers
• Workers families
• Employers and shareholders
• Government and society
• Health professionals

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Absence is complex - not just about a health
problem

• Health Professionals should focus on health
  issues
• and liaise with fellow stakeholders on other
  matters
• Health related - assessment of fitness for role
• Social/domestic such as debt, childcare, divorce
• Work-related manager/employee relationships
• Reasonable adjustment of work and rehabilitation

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Learning point 1

It is vital to have the right people dealing with
the right issues
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Matching people to employment Assessment of
fitness to work
The purpose of a medical assessment for fitness
to work is to determine that an individual is fit
or unfit to perform the tasks involved
effectively and without risk to their own health
and safety and that of others. If found unfit,
the assessment should define the limiting
parameters so that a solution may be sought.
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Medical certification of unfitness for work
A sick certificate is a frequent routine
request by patients to doctors. Doctors often
see it as a worthless, time- wasting chore, yet
offer little resistance lest they upset their
relationship with the patient. Do they issue the
certificate with little or no constructive
thought?
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Do some issue the certificate with little or no
constructive thought? If so, why?
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Do some issue the certificate with little or no
constructive thought?
Dont they care?
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Do some issue the certificate with little or no
constructive thought.
Perhaps, they dont know what the patient does
nor the demands that job imposes?
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They issue the certificate with little or no
constructive thought.
Probably, they dont know the employers
attitudes to and arrangements for reduced health
and fitness employees?
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Hurdles faced by GPs and Secondary Care doctors

• They may not know
• what the patient does,
• the demands of that work,
• the employers attitudes to and arrangements
  for reduced health and fitness employees?

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Solutions?

• Employers should examine each job
• define the demands, hazards and risks
• effect changes to maximise safety and minimise
  exclusion
• derive, publish and apply evidence based
  standards of health and fitness

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Learning point 2

• Published task-related health and fitness
  standards set by employers can be useful in
  matching people to jobs and determining whether
  workers are fit for work.

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Fit for what?Three aspects of standards

• Safety
• Health
• Functionality

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Safety-critical jobs

• road vehicle drivers
• pilots
• seafarers
• train drivers
• air traffic controllers

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Driving as a safety-critical task

• vocational, non-vocational
• perceptual requirements
• cognitive requirements
• motor requirements
• stability, sudden change
• epilepsy, hypoglycaemia,

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Driving impairment

• medical condition
• treatment of condition
• fatigue hours of work, time of day
• alcohol limits and tolerability
• illicit and recreational drugs
• age youngzest inexperience
• ageinformation processing
  impaired

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Other safety-critical jobs

• Commercial diving
• Control room operators
• Emergency services
• Armed forces
• User of hazardous materials and equipment
• Food preparation
• Steel erector
• Medical personnel

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Health-critical aspects of jobs

• Diabetes
• Epilepsy
• Back pain
• Skin disease
• Mental health
• Cardiac surgery

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Function-critical

• General - fit to be present in the workplace
• do the job effectively and safely,
• without excess risk of harm to self or other.
• Specific - fit for special aspects of tasks
• eg printers, fabric matchers, fruit selectors
  having normal colour vision

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Fit for what?

• Appreciation of Safety Health
• Function
• Ability to decide on fitness for work,
• if you know the demands of the job

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Fit for what?

• Appreciation of Safety Health
• Function
• Ability to decide on fitness for work,
• if you know the standards for the job

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Disability Discrimination Act
Does the individuals disability fall within the
definition of the Act? What adjustments may be
needed to accommodate the disabled individual in
the workplace?
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Learning point 3

• Employers should examine each job
• define physical and mental demands
• define hazards and risks
• maximise safety and minimise risk and
  exclusion of disabled
• derive, publish and apply evidence based
  standards of health and fitness

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Learning point 4

• Importance of you and the patient agreeing that
  return to work is a planned outcome of treatment
• and
• agreeing on a plan to achieve that aim

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• Forecast when will patient be sufficiently
• Safe Healthy Functional
• to agreed standards?

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Consider and act on the most important
psycho-social predictors for risk of long term
incapacity
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Low back pain

• Age
• Pain intensity/functional disability
• Poor perception of general health
• Psychological distress, depression
• Fear avoidance
• Catastrophising
• Pain behaviour
• Job satisfaction and worker disaffection
• Duration of absence/incapacity
• Whether or not still employed
• Expectation about return to work

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Is your patient fit for work?
Grant McMillan Hon Senior Clinical Lecturer
Thank you for your attention