Groups Aim to Alter Attitudes on Workplace Disability: Fit Notes, not Sick Notes?

Anne-marie Tobin, The Canadian Press
Mon, 24 Oct 2011 13:01:00 CST

TORONTO – Small organizations in Ontario and British Columbia are trying to change the mindset about health concerns in the workplace, and they’ve been looking to the United States and the United Kingdom for inspiration.

Their starting point of view is that work is healthy for an individual, and prolonged time off work on disability benefits when it’s not necessary can be
harmful, says Terry O’Hearn, chair of the Ontario Action Group to Prevent Work Disability.

“If you look at the individuals who stay on these benefits in the long term, their loss of quality of life is substantial. There’s family loss associated
with it, and there’s also a huge economic cost to it,” he said from Ottawa, where he is president and CEO of Caldwell O’Hearn, which helps clients manage disability issues.

“What motivated me is I saw too much of that tragedy in my 30 years of doing it, people killing themselves, families ruined, desperate lives after years
of struggling with an insurance system … It’s heart-wrenching, some of the cases you see.”

His group brought Dame Carol Black, past president of the Royal College of Physicians in the U.K., to Canada earlier this month for a summit and meetings in which she talked about changes that are taking shape across the pond. She’s a proponent of doctors writing a “fit note” as opposed to a “sick note.”

“Our old note was a note in which the doctor had to say you are either 100 per cent fit, or 100 per cent sick, which of course is quite silly because most
of us are never that,” she said in an interview.

“And we know in England, 26 per cent of our working population have got a disability or a chronic condition, so we needed to change a note which labelled you sick and what you couldn’t do to a note that would allow the doctor to say what you could do — functionally what you’re capable of, and then for the employee to be able to take that to the employer to see if they could make adjustments.”

Black — the first national director for Health and Work in the U.K. — said changing the notes involves changing the culture and attitudes. General practitioner education is needed, along with encouraging employers to make accommodations such as a phased return to work.

“Could you work a day a week from home if, let’s say, you’re post-cancer as an example? You’re often very fatigued when you’ve had that treatment, or if
you’re recovering from an operation, would it be possible, you know, to do something like that or phase the working hours, or come in not in the rush hour
if you work in London?”

In Britain, a GP education program is now online, and efforts are being made to educate hospital doctors, who also write some notes, she said.

O’Hearn looks to recommendations in a position paper a few years ago by the American College of Occupational Health Physicians. The report focuses on the “large number of people who due to a medical condition that should normally result in only a few days of work absence, end up withdrawing from work either permanently or for prolonged periods.”

Studies show that if someone is off work and on benefits for four to six months, there is about a 70 per cent chance the person will not go back to productive work, O’Hearn said.

In British Columbia, Lucette Wesley, president of the B.C. Collaborative for Disability Prevention, said working from home or changing a work environment are sometimes options.

“For instance, if somebody is affected by seasonal affective disorder, they get depressed when it’s wintertime and they really struggle with being able
to be at work — there’s lots you can do,” she said from Burnaby.

“You could move them in the workplace into a very sunny corner, you can get them lighting that lights up their area … You could take away some of their
duties that might be really stressful for a short period of time and then reintroduce them slowly.”

Her group’s focus is on making accommodations to keep people productive.

“That’s better for someone’s health than to go off work. Now it’s a huge shift in thinking. Physicians don’t really think this way right now because if
a claimant comes to see us and suggests that they need to be off work because x, y, z, the physicians tend to just support that rather than physicians
thinking about the whole health of the individual and thinking about all the consequences of being off work.”

Black said people often think that the problems are all medical. But in addition to back pain, the injured employee may not get along with a manager or may dislike the work environment.

“They may have home problems, they may be in debt … in order to help someone, you need to help them as early as possible and not just with the medical problems. Because if you just solve what’s the bit of medicine there, you may still not get them back to work … You just need to understand the nature of why people are not able to go to work.”

The job might be contributing to an employee feeling depressed or anxious, so the person could be better off in a different position, she said.

“We provided a national help line of occupational health advice for companies, particularly small and medium-sized companies … it’s manned by occupational health nurses who’ve had special training in mental health. And our small companies make good use of that,” Black said.

Wesley said many employers don’t know how to deal with mental health issues.

“There is still a stigma, there’s still, even when people are more open, they don’t know how to provide an environment where they can still function, and
stay at work,” she said. “And it’s not just the employer. It’ll be the co-workers as well.”

If an employee is open in talking to the employer about what’s going on, then accommodations can be made.

“But today everyone’s afraid of privacy issues and so an employer can’t ask an employee if they’re ill what’s wrong. Some employees don’t feel comfortable telling their employer what’s wrong,” said Wesley, who works in the disability claims area of Pacific Blue Cross.

O’Hearn and Wesley said their members mostly volunteer their time, and funding is needed to identify issues, get out the message and bring people to the table to start making changes. Efforts need to involve employers, physicians, insurance companies, unions, occupational therapists and more, they indicated.

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