An occupational health report should explain why a course of action is being recommended. The employer understandably get frustrated when this is omitted, leading to a perception of a poor occupational health report.
Here’s a report excerpt with no explanation of ‘why:’
The employee has a medical condition which means they will need frequent access to the toilet and may have an increased rate of sickness absence for three months. They will need time to attend hospital appointments.
All absolutely accurate, yet minimally helpful to employee and employer. The ‘why’ is boiled down to saying they have ‘a medical condition.’ The employer probably knew this already, which is why they’ve referred them in the first place – it hardly adds value. Here’s an alternative:
The employee has Crohn’s disease, which is an inflammatory long-term condition which can vary in how it impacts people over time. It affects the digestive system, so it’s important to always have access to a toilet at short notice – a disabled toilet would be appropriate if available. This will be the case for the foreseeable future even if symptoms appear well controlled. The condition can get worse and better over time and patients can experience ‘flare ups’ of symptoms which can leave them feeling very unwell. Sometimes surgery is needed but that isn’t in the treating doctor’s plan currently. The employee is working with their doctor to minimize the frequency and severity of the flare ups. In the long term I expect they will be able to provide regular and reliable service at work, but in the next 3 months they may need some adjustments to their treatment until they find treatment that works for them. In this time, they may have an increased rate of sickness absence and be asked to attend more appointments by their treating clinician. They are making good progress and I expect things will continue to improve medically, however if they are still having trouble at work in three months, I’d be happy to review them to offer further advice.
This is longer, but adds much-needed context to help the employer support the employee in the workplace. It frames the report with an expectation that the employee will experience a functional improvement, while allowing for the fact that improvement doesn’t happen for everyone, and the future is not certain. It gives a plan which allows for things to get back to normal with no further occupational health input, but also provides a safety net for further support if recovery does not go as well as anticipated.
Adding detail like this requires careful discussion with the employee as you must check what they are happy for you to share with their employer. Many employees may – entirely reasonably – not wish for you to share the name of the disease. This must be respected. However, discussing the benefits of their employer understanding how best to support them allows you to co-develop a statement which is useful in the workplace while maintaining confidentiality. An employee who doesn’t want Crohn’s disease named, may be happy with it being described as ‘an inflammatory condition’ or ‘a medical problem.’
This discussion also helps you understand nuances of how the employee engages with their workplace and how this in turn may impact upon work and health. An employee who feels their employer is supportive may be much more willing for relevant, limited details about their health to be shared to foster better workplace support. An employee who feels their employer doesn’t care, won’t listen or will try to force them out unreasonably may be more hesitant for any details to be shared. It’s vital to explore this to ensure you are giving advice that is useful for the workplace context you are advising on.
To communicate ‘why’ you recommend something you have to have considered it. This is an essential exercise to avoid producing boilerplate reports that are minimally tailored and don’t provide adequate support. Thinking about why you’re recommending a phased return, for example will cause you to ask yourself what benefit it is likely to bring, how long does it really need to be, how it’s going to be implemented practically and whether there is an alternative recommendation which may be more useful and supportive.
Occupational health reports are much better for everyone when clinicians really think about why they’re speaking to the employee in the first place, how their recommendations and advice will be perceived, and why employers should listen to them. It also makes for much more enjoyable and engaging conversations, and a much greater sense of satisfaction in the job when you’ve done all you can to support the employer and employee in managing health at work.
Many thanks to my colleague Doreen Miller for pointing out the importance of ‘why’ in a comment on my previous post, which prompted me to write this article. If you have any suggestions to improve the ‘good’ example report snippet above, please share in the comments.