Back to the grind and back on your feet
CMAJ 1997;156:1382
The CMA policy summary "The physician's role in helping patients return to work after an illness or injury" (CMAJ 1997;156:680A-C [full text / texte complet]) is an excellent document and should be widely distributed to physicians, employers and entitling adjudicating organizations (i.e., provincial Workers Compensation Boards and disability insurance carriers). I encourage all physicians to read, understand and keep this policy summary in their desks for easy reference.
I have been practising occupational medicine for 23 years, long before it became a distinct medical discipline. This summary reflects many of the long-held beliefs about work and health. A fundamental belief in occupational medicine is that work is healthy. Indeed, epidemiologists have discounted for the "healthy worker effect" for a long time. Work is often part of a rehabilitation health plan, rather than a barrier to regaining health.
Almost all return-to-work plans are appropriate and well managed. In cases where there is a conflict concerning the appropriateness of a return-to-work recommendation, there are almost always other complicating factors. Attending physicians should follow this policy and use clear, scientific reasoning to advise employers, insurers or occupational health personnel about the return to work of their patients.
Confidentiality is a key component of any occupational health program. Employers, insurers and health advisers to industry need only know the information relevant to the successful rehabilitation of the employee. Fitness to work is often independent of diagnosis. Employee consent is thus useful in managing return-to-work plans, as noted in the policy summary. Employers do not, however, need employee (patient) consent to inquire about return to work and whether work restrictions or job modifications will be required. Employers need this information to manage their workplace and their workforce. No diagnosis or medical information is necessary to make these determinations. While respecting patient confidentiality, physicians should speak to employers if asked about these issues.
The principles relevant to return-to-work plans remain risk to self and other.
James D. McDougall, MD
Calgary, Alta.
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