Even when you’re a SuperDoc, there’s nothing easy about managing return to work.  In fact, not only can it feel a bit like dancing in the dark, you also have to deal with the uncertainty of not knowing who your partner is.  The patient? The employer? The insurer? You might know who you’d prefer to sidle up to on the dancefloor, but too much empathy with the patient and too little information about their circumstances can result in serious RTW stumbles.

In 2000, the Canadian Medical Association worked with primary care and specialist doctors to develop a policy on the doctor’s role in helping patients return to work after illness or injury. 

Interestingly, this followed the development of similar guidelines in a number of Canadian provinces. In an example of a national body following the states’ (or provinces’) lead, the Canadian Medical Association adopted many of the principles and statements from the existing provincial policies.

Why were such policies put together in the first place?

Well, as I said, it’s hard being a doctor and managing return to work. A Canadian study exploring general practitioner’s views on their role in helping people return to work discovered that doctors find it very difficult to balance the needs of the patients, employers, and insurers. Close to a decade on, those challenges remain. 

In Australia, as in Canada, the primary focus of doctors remains the patient.   When the patient is hesitant or for some reason does not wish to return to work, it can be difficult for the primary care practitioner (GP) to understand and identify the issues.

To make matters worse, in the more difficult cases doctors often only get part of the information. 

Recently, I listened to the story of a patient who had lodged a series of three claims after working six weeks in a labouring job. For the ten years prior to the labouring job he had been unemployed.    He was one of three mates doing the same temporary job, who started and finished together.   All three completed the job without reports of injury.   One, who had been disgruntled about the way he was treated, lodged a claim six months later.  After that claim was accepted the other two lodged claims.  Between the three of them, they lodged seven separate claims. This patient had been to four different practitioners about his three conditions, and each of these doctors was unaware of the broader circumstances in which his claims had been lodged.

Doctors may know that “these things happen,” but are in an almost impossible situation when dealing with individual cases. Well meaning, they pursue the medical issues, but in some circumstances the issues are not medical but industrial relations.  

These cases are infrequent, but they damage the trust stakeholders have in each other. And that’s a superbig issue. 

Over 50% of the population has a long term musculoskeletal problem.   When non-medical factors are the driver, it’s very difficult for a treating doctor to know what is going on, and to determine the significance of the medical versus the non-medical issues.

With the majority of health conditions patients do well, rehabilitate themselves and return to work without difficulty. However, in complex cases, doctors can struggle to understand the issues.

Employers and insurers often neglect to provide the treating doctor with as much information as possible.  They see the doctor as an advocate for the patient (in some cases they are). But the more they are informed about what can go on, the better position they are in to be effective in their approach.

This is an untapped area for improving claims management.  Providing treating doctors with circumstance reports, reports by independent assessing doctors, and background about the work situation can help the treating doctor get a better handle on what is happening.

Briefing the doctor needs to be done sensitively, with respect for the majority of patients who have a straightforward medical condition and who deserve the best medical care we can give them. It needs to be done in conjunction with helping those with important health conditions that require early and responsive medical and claims assistance. 

Bearing this in mind, we should also remember that when a doctor understands the context of an injury or illness, they are in a better position to provide appropriate treatment and advice. Providing the treating practitioner with as much information as possible enables them to provide closer to the supercare we want everyone to have.

Next time you’ve got a difficult RTW case, do the doctor, the employee and the Boss a favour: help turn the light on so everyone can see the whole situation.