Better occupational health reports – write proper summaries

Too many follow-up occupational health reports do a bad job in summarising the case so far. It’s common to see the phrase ‘this report should be read in conjunction with my previous report,’ with the clinician assuming the reader has enough context to understand the document. I’ll explain here why I don’t think that’s good enough.

I suspect this habit comes from doctors’ backgrounds in other medical specialties. When I worked as a surgeon, my clinic letters were going to GPs and to patients’ clinical notes. They’d be stored alongside other clinic letters, and it would be easy for the reader (who was also a clinician) to get a timeline of the case by looking back through previous notes. I didn’t reproduce the history of an orthopaedic case because I could reasonably assume that the clinical record was complete and coherent. Referring to my previous report wasn’t even something to mention – it was inherent to reading clinical files.

The audience in occupational health, however, is not a clinician – it’s the employee and the employer. “Employer” might be a manager, or the manager’s boss, or a temporary manager who’s covering, or a shift leader, or someone in HR, or someone else. While some employers may have electronic record systems or access to a repository of notes, you can’t be sure how your report is viewed in practice. Access to old reports may be restricted; the person reading your third report may not be able to see the first or second. In some workplaces, reports might get printed off to read, then put in a folder in an office off the factory floor and be difficult to find. Not great for information security, but not something that you as an occupational clinician can control or account for.

When you assume the person reading your report has the full context necessary to understand your advice, you’re taking a risk that key information is not received and understood. This reduces the effectiveness of your report and the quality of your support to both employee and employer.

Unless there’s a good reason not to, key information should be in every follow-up report:

• When sickness absence started, how long the employee has been off sick, or details about frequent short-term absences,

• How many times the employee has been seen by occupational health in the current case,

• A brief overview of what’s going on (a line or two is usually sufficient),

• Any material changes in the situation which may impact attendance/function at work etc.

• What the previous plan was and whether progress is currently ‘on track’ for case resolution.

  
  

Apart from making it easier for the reader to understand and act on the advice, there are other benefits to being thorough. Writing down a good summary history makes it clear that the clinician understands the situation and has properly appraised themselves of the case (I’ve sometimes read OH reports and wondered if the authors had a clue as to what had been going on). If there are any errors in the summary, these can be picked up by the employee or employer, rather than being compounded and magnified in a chain of assumptions over multiple appointments. The impact of this can be enormous for long running cases where the employee is seen by occupational health 5, 10, or more times.

Critically, it’s also a sense-check for the clinician to make sure they aren’t just ‘going through the motions’ of following-up because they can’t think of anything better to do. Repeated statements to ‘review my last report’ can quickly add up, and it’s not difficult to get into an aimless follow-up loop.

By contrast, a report which starts by saying “The employee has been off sick for 10 weeks, this is the third time I’ve reviewed them, we had planned a return to work 4 weeks ago,” suggests that considering further support might be appropriate. The plan is not going as expected and the longer the person remains off sick the harder it will be for them to return. Taking stock in this way is the catalyst for reviewing the plan with the employee and making

it clear to the employer that occupational health is taking the matter seriously and supporting in the best possible way.

Occupational health reports should be reasonably concise – writing War and Peace isn’t helpful for anyone. But there does need to be sufficient detail for the report to stand alone – for a new manager to understand what’s going on and make decisions, knowing that key information pertinent to the case has been included.

This article is aimed at occupational clinicians and refers to occupational health practice in England