Recently it was announced that doctors would be encouraged to issue ‘well notes’ instead of ‘sick notes’, to get people back to work even if they are only doing part or some aspect of their normal job.
The underlying principle is that the longer people are disengaged from work while on a sick note, the more difficult it is to re-integrate them back into the workplace. This might be a reasonable strategy for muscular skeletal disorders, where the doctor might have the expertise to determine what the patient is or is not ‘able to do’ in the workplace. However it is more problematic for stress-related or mental ill health sources of absence.
In terms of incapacity benefit the single biggest source (representing something like 40% of the total) is for mental ill health or stress at work. In this context, many doctors are incapable of determining what activities their patients are able or unable to perform. Also, most GPs will not know the work environment of their patients, or what their problems at work might be (i.e. an autocratic boss, a long hour’s culture, a mismatch between the needs of the individual and those of the specific job, etc).
For example, what if someone at work has been bullied over a period of time by their boss, and then goes off ill? The GP might feel this person could go back to work and is capable of doing X and Y, but being confronted by this bullying again might mean that they get worse and may end up off for a longer period of time after the initial re-entry period. The important point is that GPs have certain expertise but they may not necessarily understand the particular working environment of their patients and what the stimulus for the patients problem might be in the first place.
By the way, this may even apply to patients with backache problems as well, since some muscular skeletal problems are sometimes a presenting symptom for relationship or career-related problems at work, particularly when the doctor cannot find an organic cause.
Posted by Cary Cooper
