Dr Clare Wood ( left ) Specialist occupational and environmental physician , Resile , Brisbane , Queensland .

Dr Andrew Lingwood ( right ) Director and consultant occupational and environmental physician , OccPhyz Consulting , Brisbane , Queensland .

First published online on 26 May 2023

INTRODUCTION

AS we become more aware of interactions

between health and work , both negative and positive , GPs are commonly asked to provide opinions regarding their patients ’ fitness for work .

This is not a new phenomenon . Doctors have historically played a central role in the certification of patients ’ fitness for work through the provision of medical certificates when patients are unwell or injured , and similarly with clearance certificates when an individual has recovered enough to allow them to return to work .

Recently , however , requests for medical practitioners ’ input have become more complex than a short medical certificate stating that a patient is either fit or unfit . Insurers , employers and other stakeholders may be interested in the areas in which a person may be able to participate at work , even if they are not fit for their full role . This is highlighted by the change to the process in the UK , where a ‘ fit note ’ rather than a ‘ sick note ’ is completed . 1

Employers may ask about the kind of modifications required for a worker to attend the workplace safely , or the

expected length of recovery . Perhaps the most challenging requests , however , relate to commenting on the risk of future injury to a patient if they are to return to their normal duties at work . These requests are occurring in an increasingly complex and , at times , litigious medicolegal environment . Box 1 lists some of the possible implications of the process .

This How to Treat article will attempt to navigate some of these issues and discuss strategies that may be useful in attempting to answer some of these questions .

HEALTH BENEFITS OF GOOD WORK

THERE is an increasing focus on characterising

the association between employment and health .

There are many ways in which an individual ’ s health may impact their employment . For example , some medical conditions prevent a worker from performing their role safely .

Employment also plays an important role in an individual ’ s health . Individuals may be injured , may come into contact with hazardous substances ( see figure 1 ) that can then impact their health , or they may

Box 1 . Potential socio-legal implications of fitness for work assessments

• Security of employment .

• Rejection at recruitment .

• Occupational ill health or injury .

• Justifiable or unfair discrimination .

• Retirement due to ill health .

• Termination of contract .

• Claim for unfair dismissal .

• Industrial tribunal .

• Medical appeals .

• Litigation for personal injury .

• Criminal prosecution .

• Professional liability .

Source : Davies W 1996 1

have underlying medical conditions that are aggravated in the course of their work .

It would be easy to focus on the potential negative impacts that employment can have on health , but it has become apparent through both Australian and international research that employment is also a very important positive prognostic factor in an individual ’ s overall health . 1

The Health Benefits of Good Work is a program championed by

the Australasian Faculty of Occupational and Environmental Medicine ( AFOEM ) and the Royal Australasian College of Physicians ( RACP ). 2 Its central tenet is that work is generally good for an individual ’ s health , and conversely , extended periods of time away from work are associated with a variety of negative health outcomes to both physical and mental health .

Research has also shown that the longer an individual stays away from work , the less likely it is that they will ever return to stable or regular employment in the future ( see box 2 ). 3 There is further evidence that demonstrates a poorer outcome for work-related injury or illness when compared with similar injury and illness that is not work-related . 1

The Health Benefits of Good Work Consensus Statement contends that work is an effective means of reducing poverty and social exclusion . 2 It also identifies that doctors have a central role and can exert significant influence on long-term work absence and disability . This relates to the role doctors play in educating patients about the health benefits of work and the negative health impacts of extended periods of time away from work . PAGE 37