Australian Doctor 3rd November 2023 3rd Nov 23 | Page 41

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Figure 10 . Carpal tunnel surgery .

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1 . Which THREE factors are vital in providing medical certification regarding a patient ’ s fitness for work ? a A detailed understanding of the patient ’ s medical history . b Definitive knowledge regarding whether the patient ’ s employer can provide modified duties . c Understanding how a patient ’ s medical condition may impact their function . d A detailed understanding of the physical and psychosocial demands of the patient ’ s work .

2 . Which TWO statements are consistent with the Health Benefits of Good Work Consensus Statement ? a Doctors have limited influence over long-term work absence in a patient who seems poorly motivated to return to work . b Work is generally good for an individual ’ s health . c Those with a more severe injury and a longer period off work for rehabilitation are more likely to achieve a sustainable return to work in the longer term . d Extended periods of time away from work are associated with negative health impacts .

3 . Which THREE jobs or job tasks have legislated medical standards ? a Air traffic controller . b Train driver . c Machine operator on a mine site . d Ferry master .

4 . Which THREE statements regarding the aging workforce are correct ? a Increasing numbers of individuals are remaining in the workplace for longer . b Older workers require a different approach from younger workers when assessing fitness for work . c Some older workers may have decreased tolerance for shift work . d Roles with specific visual and hearing demands may raise challenges for older workers .

5 . Which TWO statements on the impact of medicinal cannabis on fitness for work are correct ? a Preparations containing only cannabidiol ( CBD ) do not require close consideration , as CBD does not have relevant side effects . b Individuals using medicinal cannabis in addition to other prescription medications may experience potentiation of the effects of their medications . c The assessment of fitness for duty for a person taking medicinal cannabis is fundamentally different from the assessment of fitness for work for a person taking other medications , as cannabis can be an illicit substance . d Medicinal cannabis containing THC has the same potential effects as illicit or recreational cannabis .

6 . Which of the following prescription medications may impact an individual ’ s fitness for work ? a Promethazine . b Extended-release methylphenidate . c Pregabalin . d Slow-release oxycodone .

7 . Which TWO of the following statements regarding the impact of long COVID and fitness for work are correct ? a Most individuals with long COVID do not experience difficulty returning to work . b The effects of long COVID show significant overlap with conditions such as chronic fatigue syndrome . c Long COVID frequently features a combination of physical and psychological symptoms which may impact work capacity . d The fatigue seen in long COVID is most often cognitive rather than physical .

8 . In which of the following situations may a doctor be requested to provide a fitness for work opinion regarding a patient ? a In the setting of a worker ’ s compensation claim . b If a patient has been absent from work for an extended period . c In the context of a compulsory third party or income protection claim . d At the request of the patient .

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IS MY PATIENT FIT FOR WORK ?

work and found several mistakes that he cannot explain . He describes his job as very detail-oriented , and any mistakes can affect the safety and technical quality of the product . He is a supervisor and is responsible for the final checks on the work of others . While his job is sedentary , he can drive without any difficulty or pain . He is physically fit for his age but had a knee replacement three years ago .

There is no history of psychiatric illness or chronic disease , and Nitesh is not taking any medication .

On assessment , there is no evidence of acute illness and no relevant physical symptoms . Nitesh has mild hearing loss that does not interfere with communication and mild visual acuity loss , corrected by glasses . He appears orientated and appropriate , and his Mini-Mental State Examination is normal .

Although Nitesh can physically attend and perform his work , the GP is concerned about his cognitive capacity . Assessment of early cognitive decline is difficult , and Nitesh is referred to a psychogeriatrician for further detailed testing .

With Nitesh ’ s consent , his GP

9 . Which TWO statements are consistent with the Risk , Capacity , Tolerance model of work ability ? a An individual who is legally blind has both risk- and capacity-based limitations for operating machinery . b The report of pain when performing a task at work is the primary consideration when determining if continuing that task will increase the risk of injury . c An individual with chronic intermittent low back pain who experiences pain when sitting at a computer station has capacity-based limitations for this type of work . d Symptom tolerance for pain and fatigue is extremely difficult to classify or quantify medically .

10 . Which ONE statement is correct regarding consent in fitness for work matters ? a If an injured patient presents requesting fitness for work information from their insurer , the doctor can reasonably assume the patient is consenting to the provision of such information . b Because a third party is involved , there are a different set of principles of informed consent in fitness for work matters than in other aspects of clinical practice . c Advice in complex cases may need to be sought from a doctor ’ s MDO . d It is important for doctors to warn a patient to seek legal advice if the patient ’ s employer has requested information on the patient ’ s fitness for work . speaks to his supervisor . They arrange for Nitesh to reduce his hours temporarily and work on a less technically complex project , with a colleague available to assist and oversee his work where necessary , while he undergoes assessment .

The psychogeriatrician diagnoses early cognitive decline . His employer arranges for him to move permanently into a sales role , where his technical knowledge is still used , but he is not responsible for technical accuracy on safety and detail-critical work . He undergoes regular reviews by his GP , geriatrician and occupational physician .

Nitesh remains with his employer for a further three years before deciding to retire .

CONCLUSION

THE assessment of fitness for work is a challenging task . Doctors are increasingly being asked to provide more complex opinions about their patients ’ work fitness in environments where there may be multiple agendas at play . It is a situation that can strain doctor-patient relations , and there are potential medicolegal pitfalls .

A detailed understanding of both the patient and the work environment is vital when providing your opinion . There are some situations where there may be medical standards or other guidelines available ; however , there are equally times where a greater degree of clinical judgement , or assessment from first principles , is needed .

The Health Benefits of Good Work program has demonstrated 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 . This is a challenging area , so doctors who can work with their patients and their patients ’ employers ( with appropriate consent ) to facilitate safe recovery at work or return to work are , in most cases , acting in the best interests of their patient ’ s health .

Occupational and environmental physicians ( OEPs ) have specialist training in the interactions between work and health , and regularly provide expert opinions on fitness for work . GPs can always seek advice from or refer patients to OEPs in complex cases .

RESOURCES

• RACP — Find a specialist bit . ly / 3UZd6hq

— Health Benefits of Good Work — an initiative from the Australasian Faculty of Occupational and Environmental Medicine ( AFOEM ) of The Royal Australasian College of Physicians ( RACP ). bit . ly / 2CrNrt0

— Garnett A , et al . Employment law : A guidance note for general practitioners on providing patient information to employers . Aust Fam Physician 2017 ; 46 ( 8 ) bit . ly / 3GFD3OO

• The Society of Occupational Medicine ( August 2022 ). Long COVID and Return to Work — What Works ? bit . ly / 3XoGqzs

References Available on request from howtotreat @ adg . com . au