To better predict which ill or injured employees are likely to have more difficulty than others in returning to work, could doctors improve their assessments of patients by broadening the questions they ask?

There are numerous studies predicting which workers will return to work quickly, and which will be off long term. A particularly nice one done in the Netherlands found GPs’ general sense of the situation was just as good as any questionnaires or prognostic studies they performed.

Interestingly, the higher the patient’s risk of slow return to work, the more likely it is that the doctor is going to focus on the biomedical model, i.e. focus on the physical condition rather than other issues surrounding the physical ones, such as workplace issues.

Is this because of the way the patient presents, and the doctor’s concern about not causing further distress?

Whether this is the case or not, doctors are good at assessing pain severity and the physical demands of work, but are often less inclined to consider things that can be even more important in return to work, such as how the supervisors are responding to the employee’s injury, and whether the work place will be supportive of return to work.

This can only be determined by asking the right questions.

The most important question of all is about the individual’s expectations for recovery and return to work. There are simple questions to ask, such as:

• Do you think you’d be able to do your regular job in the next month? (or next three months); or
• Do you think you’ll ever be able to get back to your regular job?

Assessing a person’s fear of their condition is also important, and a simple way of assessing this is to ask the patient how worried they are that the physical things they do at work will increase (for example) their back pain or harm their back. It’s also worth asking if they think their job is likely to cause a reinjury.

One screening question for depression is also worthwhile. A simple “Have you had feelings of sadness or depression over the last three months?” seems to be reasonably reliable.

Of course the doctor needs to have a good relationship with the patient to ask sensitive questions. If the patient thinks the doctor is telling them the problem is “in their head” they may not necessarily give accurate answers.

The patient needs a sense of partnership with the doctor to answer straight, and the doctor needs a sense of partnership with the patient to be able to explore all the issues.

Identifying the “high risk” patient is one thing, but identifying issues that cause the patient to be a high risk is more important. Many of these issues can be addressed, but first they need to be identified.