1. 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

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

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

13. CONFUSED SUPERVISOR

14. 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

15. 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

16. 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

18. 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

19. 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

20. 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

21. 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.

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

23. 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

24. 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

25. The End
Thank you