Comments are closed. A consultant in occupational medicine says there is an obvious solution tothe escalating problem of GPs issuing sicknotes without any seriousconsideration of the consequences for employersI have been following the discussionsaround managing employee sickness and feel compelled to add a couple ofreflections. I am a specialist occupational physician working in both the corporate andpublic sector. In one area of my life I am an employee, and in the other,regularly act on behalf of employers and employees. I deal with employment lawyers, pension funds, private medical insurers and,occasionally, the court system. I have also seen the detrimental affects onteam members when one of them is ‘off sick’ for a long period of time andothers have to pick up their work; particularly if it is felt that theindividual is ‘working the system’. In reading the different views from HR, there is an overwhelming sense that eachof the different ‘stakeholders’ appears uninformed about the factors drivingthe others. By factors I mean legislative frameworks, professionalrequirements, some of the emotional underpinnings that may drive behavioursand, possibly, the nature of disease itself – particularly its relationship totime. I would like to suggest an approach that removes accusations andcounter-accusations. Imagine a situation where we spend that energy in looking at each ‘party’ asthe member of one team. In other words, address the issue as one ofteambuilding. It is just that in this case, the team members work for differentemployers. First, try to establish a common goal. Something like ‘let’s invest the timeto obtain as clear a diagnosis and prognosis as possible, but with the aim ofgetting the employee back to work’. Then look at the roles, responsibilitiesand driving agendas for each of the ‘team’ members and aim to achieve a way ofworking together to reach that goal. The GP, for example, is the first link in the chain and is expected todiagnose and explore the workplace environment within a five- to 10-minuteslot. Their primary responsibility is to the individual and they normally haveno understanding of the knock-on effects of sicknote decisions. The GP is unlikely to be able to probe much beyond what is presented and isoften working within an NHS not geared up to getting people back to workquickly (eg, waiting lists for specialist diagnoses). They are bound by patientconfidentiality (which can extend to what is written on the sicknote). Also,doctors know that time is a key feature in disease – it can heal or reveal – sowhile not always obvious to others, the GP may be buying some of that time toachieve a clearer diagnosis. The employer and its HR department is unlikely to have spare capacity toabsorb someone away. It has to be aware that every ‘sick’ case can set aprecedent, and needs to balance the needs of the business (including the needsof other employees) against that of the individual. The employer is desperate for precise diagnosis and prognosis to allow forplanning, despite the fact this is often impossible. The employer is alsoworking within a growing raft of legislation, which is often so prescriptiveand restrictive as to invalidate the very thing that would probably allow themost mutually acceptable and human resolution: skilled, honest conversationsall round. The patient/employee wants to keep an income as long as possible – whetherjustified or not. They may really want to come back to work even if to do sowould be detrimental (eg, some musculoskeletal issues) and not to allow them todo so might precipitate another form of anxiety-related illness. So let’s imagine addressing this as we would as a team of individuals. Theproductive way forward would be for each to spend time understanding the issuesof the other and, equally importantly, educating the others in their own issuesand constraints. Here I feel my own speciality of occupational medicine could be moreproactive. We should act as facilitators among this group of diverse agendas.We have the privilege of being able to discuss patients within the bounds ofmedical confidentiality. We understand (or should) the pressures of those in industry and the factemployers do not have the luxury the GP does of only having the oneindividual’s interests as their driver. They have other employees who rely ontheir management to manage and resource appropriately. We should be educatingthe employers about the pressures experienced by GPs and vice versa. One solution would be to recommend a system whereby a GP can only sign anindividual off work for a specified amount of time before having to refer to anoccupational health specialist to work together to achieve the goal. This wouldstill mean there were occasions when the other stakeholders believe they arenot receiving sufficient information for their own purposes – but might be astep on the way. There could be different solutions, but they all rely on a willingness notto assume the worst of each other. Otherwise, the only real losers will be thehonest employees. As we move towards an increasingly knowledge-based employment base, I canforesee the issue becoming worse. It is this type of economy that breeds themost difficult of all cases to handle well – those linked to the mental ratherthan the physical state. We can all see the inevitability of this area increasing so surely this is agood enough reason to take a more holistic approach for the benefit and sanityof us all. Dr Tony Yardley-Jones is an independent consultant in occupational medicineand works part-time at the Chelsea & Westminster and London Bridgehospitals By Dr Tony Yardley-Jones, Consultant in occupationalmedicine Previous Article Next Article Teamwork approach is key to halting ‘sicknote syndrome’On 16 Sep 2003 in Musculoskeletal disorders, Personnel Today Related posts:No related photos.