Managing conversations about health and work

Patients who have a work related injury or illness sometimes enter the consulting room feeling vulnerable and unsure about their condition and abilities. They may be anxious about their work situation. How will their supervisor deal with them? Will they be able to cope with the tasks they are assigned?

Patients on disability or unemployment benefits may have been out of the workforce for a long time. They might have entrenched ideas about what they are and are not capable of, and what kinds of abilities and disabilities can be accommodated at work.

Being out of work for long periods is associated with:

• Increased rates of overall mortality, and specifically increased:
  • mortality from cardiovascular disease; and
  • suicide;
• Poorer general health;
• Poorer physical health, including increased rates of:
  • cardiovascular disease;
  • lung cancer; and
  • susceptibility to respiratory infections;
• Poorer mental health and psychological wellbeing;
• Somatic complaints;
• Long‐standing illness;
• Disability; and
• Higher rates of medical consultation, medication consumption and hospital
  admission.

The treating practitioner has a significant influence on whether the patient remains in or
returns to the workforce.

Simple messages delivered in the clinical environment can encourage patients to develop
evidence‐based views of the relationship between health and work.

Evidence‐based messages include:

• "Work is an important part of rehabilitation.”
• “People off work often become isolated and depressed, and that is not what I want
  to see happen to you.”
• “Being off work is more detrimental to your health than smoking. Actually, it’s worse
  than smoking 200 (yep, 200) cigarettes a day.”
• “The longer you’re off work, the less chance you have of ever returning.”
• “Most common health conditions will not be cured by treatment.”
• “You’ll have some soreness in your back getting back to this job. But we need to get you going and the pain will improve as you get fitter. If we didn’t get people active after an injury we’d have no footie players in Australia.”
• “Typically, waiting for recovery delays recovery.”

It is also important to seek information about the patient’s situation and their attitude
towards work. Ask:

• “What are your concerns about work? ... What else? ... Is there anything else that is
  worrying you?”
• “Is there anything I can do to support you getting back to work?”
• “Why do you want to work? Why is work important to you?”

The next step is to seek the patient’s assistance in developing a plan of action that will allow
them to take advantage of the health and wellbeing benefits of work.

Appropriate actions include:

• Recommending a graduated increase in activity levels;
• Helping set a timeline for return to work;
• Talking to the employer;
• Collaboratively identifying obstacles—and solutions—in the workplace; and
• Identifying possible sources of support, including family members, co‐workers and
  relevant government services.

For more information about Realising the Health Benefits of Work, and for additional
resources including audio interviews with Australasian Occupational Physicians and video
presentations by Professor Sir Mansel Aylward, and Professor Dame Carol Black, go to
http://www.afoem.racp.edu.au/page/media-and-news/realising-the-health-benefits-ofwork.