Introduction

Hospital stays for most surgical procedures tend to be short and it often falls to the GP to provide post-operative follow-up, including fitness for work advice. The evidence base11 demonstrating that work is generally good for health, because it can be therapeutic and so can aid recovery, is expanding. However, Waddell; Burton4 and Black3 note that common misconceptions still exist, and therefore need to be tackled. These misconceptions and current evidence-based arguments which dispel them are shown in Figure 2.

Figure 2: Common Traditional Misconceptions and Current Evidenced-Based Counter-Arguments.
Common Traditional Misconceptions Current Evidence-Based Counter-Arguments
Work can be harmful and therefore impede recovery Work is generally good for physical and mental health. The longer one is away from work, the greater the likelihood that ill-health and incapacity will be experienced.
One needs to be 100% fit to be in work / one needs to be completely ‘cured’ before returning to work. An individual can experience symptoms regardless of whether or not they are in work. Work can provide a source of distraction and can build one’s confidence through achievement and social interaction. Work itself can be therapeutic and aid recovery. The risks to health of being out of work; generally outweigh the risks of returning to work. Conversely, the benefits of returning to work early; outweigh the risks of being away from work. One does not therefore need to be 100% fit to be in work. Work is itself the best form of rehabilitation.
Receipt of health-related benefits implies that one is totally and permanently incapitated from work Many people with severe medical conditions and/or severe impairment are working. An even greater number are out of work due to mild-moderate subjective health conditions of a primarily psychosocial nature. In light of The Social Security Incapacity for Work Act 199412, one should ask “Is it reasonable to expect me to seek or be available for work?” and “Can I do some work?”

Sources:

  • 3Black, C. (2008) Working for a Healthier Tomorrow. London: TSO; 
  • 4Waddell, G. And Burton, A. K.(2004) Concepts of Rehabilitation For the Management of Common Health Problems. London: TSO.

Traditionally, employers and health professionals in their duty of care to patients/employees may have encouraged absence from work in order to promote recovery. The evidence4 now shows that sickness certification serves to legitimise and reinforce the sick role and promotes illness behaviours which lead to long-term incapacity. Waddell and Burton4 note that:

“Sick certification is one of the most potent health care interventions for common health problems and, just like any other intervention, it is important to consider the indications and contra-indications, its likely impact, and its potential risks and side-effects. Doctors should always consider carefully whether advice to refrain from work represents the most appropriate clinical management and whether it is in the patient’s best long-term interests”.


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