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“Work itself is a form of rehabilitation.” —Dr. James Mason, former physician for Care Point medical centre in Coquitlam, B.C. But, he acknowledges that even when those subjects are taught in medical schools, they’re covered only briefly. “In years past, essentially minimal-to-no training has been given to physicians or physicians in training around work disability prevention or disability management,” Rothfels says. Doctors and employers need to talk to each other sooner And helping patients return to work involves so much more than filling out a form. “What we’re talking about is changing physician behaviour, so they better understand what it means to return to work and resume life’s activities,” he says. “We want physicians to understand the differences between medically necessary time-off and medically discretionary or unnecessary time-off. It’s up to the physician to help set reasonable expectations about returning to work, whether it’s in a modified or light capacity — and at least starting that conversation early.” To help doctors support injured or ill workers, the project’s researchers surveyed patients, employers, and physicians, and then used the responses to develop content for a physician education program. Physicians reported lacking confidence in identifying individuals at high risk for prolonged disability. They said they would be better able to help patients return to work if they had the following: more support to assess ill and injured workers’ functional capacity; more information on stay-at-work and return-to-work guidelines and the role of patient confidentiality; more information from employers about job demands and support services; and more training to help patients understand the importance of returning to work. Work-return benefits patient health It’s a concept that can’t be emphasized enough: Scientific evidence abounds about the negative physical and mental effects of prolonging a work return. “There’s still a lack of awareness about the serious health risks associated with being off work,” says WorkSafeBC senior medical advisor Dr. Craig Martin. The longer people are off work, the less likely they will ever return. The likelihood of an employee returning to work from a prolonged health-related absence falls to 50 percent after just six months away from the workplace, according to the Conference Board of Canada. “A lot of family physicians don’t recognize that work is a social determinant of health,” says Andrea Keesey, director of Continuing Professional Development at the UBC Faculty of Medicine. “What’s needed is a cultural shift. “One of the study’s objectives was to encourage physicians to ask patients about return-to-work expectations during a first visit, and we realized that’s not happening as often as it should,” she says. “Patients’ — as well as physicians’ — expectations are part of the prevention of unnecessary work disability.” The study also identified the importance of opening up communication between employers and doctors. Surveyed employers said they wanted better communication, as well as standardized forms for illness and disability cases. “There can be a collegial relationship working together; being aware of each other’s roles is vitally important,” says Brenna Lynn, associate dean for Continuing Professional Development (UBC Faculty of Medicine). Work disability prevention a key goal Nearly 300 physicians participated in the pilot educational program, which consisted of community-based workshops and webinars. The pilot program proved hugely successful. Participating physicians felt increasingly able to 22 September / October 2015 | WorkSafe Magazine
identify patients who may be at risk for prolonged work absences, create an “activity prescription” for patients with a timeline for recovery, and complete employer and insurance work-absence forms. Participants said the program also increased their understanding of language specific to work disability (such as “limitations” and “restrictions”) and boosted their confidence in managing patients on sick leave. Dr. Celina Dunn, WorkSafeBC manager of medical services, says medical schools, residency programs, and continuing education programs for doctors should more extensively cover stay-at-work and return-to-work principles. “People do tend to listen to their doctors. And, it is beneficial to have doctors help patients fulfill their work roles and manage that transition time with safe modifications in consultation with employers,” Dunn says. Based on the success of the pilot program, the doctor outreach process is now in its second phase, with a planned provincial roll-out consisting of more workshops next year. Doctors gain a new appreciation for their role Doctors say they’re also interested in building bridges with employers to help patients get back to work. “I see a doctor’s role largely as a cheerleader,” says Dr. James Mason, a family physician of more than 40 years. “Work itself is a form of rehabilitation. Success for these workers comes from all of us being on the same page — the employer, the patient, and the rehab team.” Rothfels says a successful return to work encompasses much more than a person’s professional role. “Work is a significant part of people’s lives. It’s not only about a return to work, but a ‘return to life.’” Lori Guiton, WorkSafeBC director of Research Services, says everyone benefits when doctors receive the right tools to better support injured and ill workers. “This pilot project is a great example of how research can show us where the gaps are and make the whole system stronger for health care practitioners, workers, and employers.” W September / October 2015 | WorkSafe Magazine 23
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