When a doctor hands a patient a prescription there is an expectation that the treatment recommended will be based on evidence.  That is, that the doctor will take into account research evidence regarding good management of the patient’s condition.

Modern medicine requires the doctor to take into account the science behind the health condition and the treatment, the side effects of any treatment, short and long-term outcomes, consideration that balances the benefits and potential problems arising from the treatment.

Patients expect this of us.

In contrast, a sickness note or a prescription for time off work does not carry the same demands and level of rigor.

Sickness absence is a major issue in industrialized countries around the world.  Most countries have public or private systems to fund time off work, and disability or sickness absence costs are substantial.  Sickness absence costs many countries between 20 and 100% of their total health budget.  In Australia sickness absence is estimated to cost 4% GDP, with health care running at around 8% GDP.  It has major impact on the individual, their families, their work places, and society.

However, there is scant attention paid to this issue and an incredible lack of rigor in the assessment process of sickness absence.  There is minimal research, little in the way of guidelines, and as a consequence little opportunity to train medical professionals, other health practitioners and claims staff about appropriate methods of assessing and applying sickness certification.

Many in the workers' compensation system rely on doctors to assess a person’s capacity for work, yet without adequate research and training doctors are poorly equipped to deal with this responsibility in an effective, professional manner.  This aspect of the system is dealt with in a lax fashion, because there is insufficient research to enable better practise.  Stakeholders are frustrated, and doctors are subject to external pressures from patients, employers, and claims staff.

Internationally, countries such as the Netherlands, Sweden and the UK are endeavouring to bring more rigor to the process.  However, this is difficult without good research on which to base guidelines.  Major funding is required.  The area needs investment, coordination across different branches of health and societal research, and a better assessment of causes and the consequences of sickness absence.

Training in sickness certification involves assessing a person’s work ability, their positive capacity, a good understanding of the health condition and the expected consequences of it, effective communication skills, the ability to handle disagreements, and a solid understanding of the consequences of a person remaining off work.

The human and economic cost of work absence is huge. 

Short term and crude measures such as the premium cost for compensation and the degree of funding liabilities may be important at a political level. 

But at the individual and human level, we need better research and understanding of prescriptions for time off work.  We need this for the health of the individual and for the health of the system and our community.