RETURN TO WORK ESSENTIAL COMMUNICATIONS DR. D. MOYO MBChB(UZ), MFOM(RCPI); MOHS, MAppMgnt-(Australia), CIME (US) SPECIALIST OCCUPATIONAL PHYSICIAN SASOM CONGRESS 10 JUNE 2016

OUTLINE Roles and value of communication Fundamentals of fitness for duty decisions Essentials of a medical report to the employer

WORKPLACE COMMUNICATION Doctors often required to communicate fitness for duty of workers. On request by employer or benefit administrators Progress report, Medical report, RTW slips, Required for decision making

WORKPLACE FUNDAMENTALS Safety Sensitive work: Precision Eggshell Skull Principle Pre-existing medical conditions Positive vs Negative statement: Fit note vs Sick note

EFFECTIVE COMMUNICATION Coordinates employees Fulfills employee needs Supports knowledge management Improves decision making Minimizes the “silos of knowledge” problem that undermines an organization’s potential

COMMUNICATION One Study showed that a company’s market value increases over 7 percent when it improves its communications integrity (McShane.S.L & Von Glinow M. A. 2005) 6

COMMUNICATION The process by which information is transmitted and understood between two or more people. Understood: Transmitting the sender’s intended meaning is the essence of good communication. Doctor – employer – employee relationship Fitness for duty

COMMUNICATION PROCESS MODEL Transmit message Sender Receiver . FORM MESSAGE ENCODE MESSAGE RECEIVE ENCODED MESSAGE DECODE MESSAGE Production pressure Safety critical Work Safety culture Interpersonal problems NOISE DECODE FEEDBACK RECEIVE FEEDBACK ENCODE FEEDBACK FORM FEEDBACK Transmit Feedback

ITS BETTER TO BE AT WORK Confidence & self esteem Illness, injury or disability = inability to work Extensive evidence: work & health Beneficial effects of work vs risks of work & effects of worklessness Unemployment & Poor health 9

RETURN TO WORK As early as its safe to do so: Conditions the worker physically Restoration of habits and structure of work Reintegration of the worker socially within the work place Early and safe RTW reduces costs of sickness absenteeism

CONSTRAINED COMMUNICATION Light duty – Rehabilitation bay Indefinite sick leave Sick off for 7/52 and we will decide on review Not to lift heavy objects

CONFUSED SUPERVISOR

MEDICAL REPORTS/FITNESS REPORT Communication with the employer Unambiguous and precise Assessment should aim at giving a positive statement about the patient’s abilities Fit note vs sick note 14

RECOMMENDATIONS FOLLOWING ASSESSMENT Capable without ill effects Capable but with reduced efficiency & effectiveness. Capable but adverse effect on their health Capable but risk to sig. others Physically & mentally incapable for the work in question 15

CONTENTS OF THE MEDICAL REPORT Employer to obtain prior written informed consent from employee Employee has a right to see the report Has the right to refuse to allow report to be sent. Typewritten, clearly laid out, signed and dated

MODEL LETTER What is the likely date of return to work? Full duties or modified duties The date of the next appointment Management planning for work Over time Recruitment of a contractor Re- organization of work 5/30/2018 18

2. RESIDUAL IMPAIRMENT Will there be any residual impairment? Will it be permanent or temporary Will the worker be able to render regular and efficient service Puts the employer in a good position to plan their work and accommodate the employee

3. LIMITATIONS Describe any functional limitations Functional Limitations: What the patient can not or is unable to do. The shortfall between the worker’s physical stamina, strength, ability etc and the job Not a medical issue, all people have a limit

4. MEDICAL RESTRICTIONS Specific medical concerns or protective circumstances - safety Not to be modified without the doctor’s consent States what the patient should not be allowed to do or what the employer should do to accommodate.

5. Other contents Health & safety implications to be noted Adaptations Ergonomic alterations “Reasonable adjustments to the work”

LIGHT DUTY Often used to encourage early return Meaningless term without description of what worker can or can not do. Modified duty with (specific restrictions and recommendations Challenge: Demand for 100% work capacity

SHIFT ATTITUDES Fit note & positive statement. UK That work will be harmful vs current evidence That rest from work is therapeutic vs evidence That the patient should be 100% fit

The End Thank you