[Deep voice with echo required to read intro] Previously on Tales from an Anonymous Doctor our superhero-by-night/doctor-by-day brought us challenges and limitations to doctors providing guidance for and accurate diagnoses of  medical conditions. This edition Super-Doc brings us return to work: restrictions and common sense.

You can use your normal voice again now. Something occurred to me as I was saving a kitten from a tree a few nights ago. I could've waited for a fire truck to arrive, but I knew that kitten was terrified and its owner was distressed. I didn't want to waste time, but I didn't want to reveal my secret superpowers. So I problem-solved. Remembering my invisible cape, I pointed to a non-existent object in the distance, distracting kitty's owner by saying ‘Wow, look over there!' and twirled into invisibility. Before the owner could say ‘But there's nothing there' I'd flown to the top of the tree and brought puss back to safety.

What's this got to do with RTW? Well, sometimes we need to think outside the square.

The more we focus on the rules of a situation the less flexibility there is and the less common sense can prevail.

Over the last few decades there's been an increase in focus on assessment, process and following rules; everywhere from education to car licensing, but particularly in the area of health and safety and return to work management. No doubt tightening systems can improve safety, and no doubt providing modified duties increases the likelihood a person will return to work.

However, we shouldn't stop there when thinking about helping people to successfully return to work. If a focus on work restrictions and doctors' certificates comes at the expense of common sense, results will be negative.

Work duties need to be practical and workable for the employee and the workplace.

At the moment many certificates are specific and restrictive.  There can be restrictions such as no pushing, pulling or twisting, or hours of work that progress very slowly.   Some certificates recommend 10 to 15 minute rest breaks every hour.    Hours of work are often limited and slow to increase. 

These restrictions can be overly limiting. A worker who remains on a return to work program that recommends three hours of work a day, three days a week for some months will naturally become disengaged. Not only that, coworkers will start to distrust the worker and the situation.

Having an engaged, productive worker who is part of the team is a vital element of successful return to work. It impacts the person's confidence, sense of self worth and their interactions with coworkers. It also has an impact on other people's perception of the system.

So what are the alternatives to severe and limiting work restrictions?  Here are some ideas that come to mind.

One of the smartest things I've heard from an employer, speaking at a conference, is the idea of returning a person to their normal shift and their normal area of work as an extra. Rather than transfer the person to a different shift where they could be better supervised or where there's a broader range of alternate duties, this employer brought the person back to their normal shift and simply had them as an extra employee. This allowed the worker to:

• maintain contact with their normal colleagues
• continue their everyday work flow, and
• work within their capacity.

The worker back at their normal hours in their normal work environment may be doing less; however, the flow of their work and life habits continues. Working as an extra means any work done helps coworkers rather than causing them to take on extra work.

Now, this situation may not be applicable or available to all workplaces, but the principle of continuity of the normal work hours and work relationships is an important point.

Flexibility with hours is another option. Occasionally doctors write certificates that, rather than saying a person can work four hours a day, say a person can work four to six hours, leaving room to move. I endeavoured to do this last week but both the patient and their employer were quite uncomfortable about the notion of such flexibility. They wanted clearer guidance. It was a shame as the worker was a committed individual and there were lots of duties for the worker to do in the workplace.

If a workplace can allow this flexibility it supports trust in the worker, allows them to focus on getting the job done but still gives them the option of knocking off early if their situation is problematic. This is a transitional option, not a long term one.

Having 10-15 minute rest breaks each hour might sounds simple enough.  A time to rest and recuperate, or change position.  However this is such an abnormal situation for some workplaces that it can be quite damaging for workplace relations.  Also, it takes the focus off the person being engaged in their job. A better option is short pause breaks so the individual can stretch intermittently but can still be productive in their role.

One of the more positive ways of dealing with return to work is to support the individual and their supervisor to understand the problem and give them the tools to work out work duties.

Supervisors get frustrated dealing with return to work problems. If they have to follow unrealistic restrictions their difficulties increase.  With the best intentions in the world their frustrations are often evident. 

Teaching them about ergonomics, communication and getting them to work with the individual has been shown to pay off. 

If we spent as much energy on teaching the individual and the supervisor about the problem, the person's needs and how the situation can be dealt with, as we do on following certificates employees and their employers would be better off.

[...and with a swirl of his invisible coat – poof! – our superhero is nowhere to be seen, off to save more kittens and other superhero-ish things.]