If you’re an occupational clinician, your management referral reports should contain a plan. It should be clear to the employer and the employee what your recommendations are and, how you see things going forward.
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The plan is your statement of how things are going to be resolved, and what actions you recommend to get to that resolution. If you think it’ll take 4 weeks for someone to get back to doing their full job, say so. If you think someone will need 4 weeks’ counselling, and that after that they should be able to get back to work with a couple of weeks’ phased return, say so.
In making a plan, you are not staking your professional license on your ability to predict the future. You’re using your medical expertise to outline what the most likely course of events is, and what actions will help that course of events take place. Too many occupational health clinicians avoid giving an opinion because they don’t feel absolute certainty about how a condition will play out. This is not really good enough.
Most medical conditions follow somewhat predictable patterns. Some are more predictable than others – a sprained ankle is likely to be better in a few weeks, a new diagnosis of Crohn’s disease may involve periods of severe illness, times of relative wellness, surgery, adapting to new medication and substantial sickness absence. Or it may not – it all depends on the individual employee’s circumstances.
Although you may not know exactly what will happen, what you can do is explain the range of possibilities to the employee, let employers know what to expect, and help both in navigating their health issues in the context of their employment. If there’s uncertainty in what’s likely to happen, say so – but make a plan for the best and worst case scenarios where the range of uncertainty is wide.
A recommendation for you to follow an employee up in 4 weeks’ time is not a plan. Follow-ups should be one part of your plan (when appropriate) to support resolution of the case, not to kick the can down the road because you don’t want to commit to giving useful advice.
Making a poor plan in an occupational health appointment, or neglecting to make one at all, can prolong sickness absence. Someone with mechanical low back pain sees an OH clinician who doesn’t like making plans. The employee get some vague advice about doing physio, not taking too many painkillers, and an invitation to a follow up appointment in 4 weeks to ‘see how they’re getting on.’ The employee sees physio a week before their follow up, isn’t better, and needs another 4 weeks off work.
The same person in a parallel universe sees an OH clinician who wants to support employees back to work. They take a good history, explain the employee isn’t at risk of doing any damage by exercising, and that actually keeping moving is really important. Motion is lotion! They recommend physio, and also give the employee some links to YouTube videos on back exercises to get some practice in before physio starts. The clinician makes it clear that people get better from back pain and that they expect the employee will be like most people – why wouldn’t they be? They make a plan for them to go back to work in 2 weeks’ time, and suggest that if they need it, their manager can consider a short phased return. The employee is back at work in 2 weeks, doesn’t feel they need a phased return, and despite the odd twinge makes great progress. They have their physio appointment a week after they get back to work, they get some advice on more exercises to do if they have a flare-up again, and physio discharges them.
Most people who see occupational health go back to work. The OH clinician does a great service to the employee and employer by using their expertise to lay out their understanding of what functional limitations there are, what actions are needed, and what they expect to happen in terms of recovery with treatment. If things take longer than expected, the plan will include an optional review after a specified period of time to check if other support can be suggested.
This post refers to occupational health practice in England.