When I was training as a doctor I was taught that the easiest way to do my job was to listen. “The diagnosis,” my teachers told me, “will come from the patient's mouth, if you listen long enough.” It's all about getting the full picture, a complete history, and ensuring that everything the patient has in their mind is communicated to you.

Why doesn't that always happen?

Because often the patient won't tell you everything. There are a whole raft of reasons for this reticence. People say what they think they should be saying. They don’t want to take up your time. They don’t think it is important or relevant. They haven’t been asked the right questions. They are reserved about expressing their deepest fears.

In the right environment real communication between doctors and patients, between workers and RTW Coordinators, between claims managers and claimants, can take place.

Millions of dollars are being spent on “predictive modelling” for return to work. These models are used to predict which workers are at high risk of having a delayed return to work.

And yet...

When all the research is reviewed, the best predictor is what the employee says.

A simple question, such as, “Do you think you will get back to work / your normal job in the next three months?” is the most reliable way of predicting the outcome.

The employee/ claimant is the person who knows all the variables.  

They know the factors that are obvious, such as their age and the nature of their job. They are also aware of other issues, often hidden from those assessing the situation; factors such as their concern about their health condition and aggravating it through work, whether they feel they will be supported on return to work, attitudes of their family, motivation to be back at work, or the lingering resentment they have towards their supervisor because of a conversation three months prior.

Above all the sophisticated models, the employee's response to this simple question is the best predictor of whether they are actually going to get back to work.

But wait there's more...

The employee is also the best person to let you know about factors that will improve the likelihood of return to work, and the barriers to return to work.

As RTWMatters has previously noted, motivational interviewing provides a framework for assessing an individual's motivation. When RTW is delayed, it is always worthwhile to canvass what would motivate an individual to come back to work—and what's getting in the way of it.

Simple questions such as, “Why do you want to get back to work?” and, “Why is it important to you to be back at work?” will provide important hints about what you can do to support the employee.

On the other hand, you can ask: “What's getting in the way of you coming back to work?” and, “What are the barriers, what are your concerns, what do you need?”

In the real world

Last week, a woman who works with disabled children visited me in my capacity as an occupational physician. Any time a discussion came up about return to work there seemed to be a reason it should not occur. I was becoming increasingly frustrated about her negativity. You think I'd be used to dealing with this sort of situation, and really I am. However, we don't always get into the right zone - it’s easy to ‘blame’ the person for not being motivated. Luckily something went “clunk” in my brain, with a switch to a more productive line of questions.
   
It became evident that along with her substantial anxiety and low confidence, she didn't understand that alternate duties could be provided at work. She had all sorts of other worries and her pain areas were spreading. But at the heart of it was a concern that she was not ready to cope with some of the children she had been dealing with prior to going off work. Once she was aware that alternate duties were possible, her body language changed and her facial expression altered.

It was also interesting to notice my reaction, as the conversation became enjoyable rather than filled with a stiff resistance.

There are layers of complexity within the our current compensation and insurance systems. It might sound like glaringly obvious common sense to suggest you have a simple conversation and ask a simple question. But often, this kind of simplicity is exactly what is missing.