Lots of studies have been done seeking to predict which workers with an injury will return to work quickly and who will be off work for long periods. 

A fascinating study done in the Netherlands found general practitioners’ general sense of the situation was just as good as any of the questionnaires or prognostic tests that tried to predict the outcome. 

But could doctors improve their assessment of the situation by broadening the questions asked?

Interestingly the higher the risk of the patient becoming a long term case, the more likely it is the doctor will focus on the biomedical model, i.e. focus on the physical condition rather than other issues. It’s interesting to reflect on whether this is because of the way the patient presents, and the doctor’s concern about not causing further distress.

Either way, the things that make a difference are often work place issues.

Pain severity makes a difference and doctors are pretty good at assessing this. Understanding the physical demands of work is important, but more important factors include how the supervisor has responded, and whether the work place is supportive of return to work.

The most important question of all is about the individual’s expectations for recovery and their expectations for 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 “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.   A simple way of inquiring about this is to ask the patient how worried they are about the physical things they do at work harming their back, or delaying the healing process. 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 a reasonably reliable screening question for depression.

Of course the doctor needs to have a good relationship with the patient to ask sensitive questions, if the patient thinks the doctor is saying “it’s in their head” their answers may not necessarily be accurate. 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 these 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 them can be addressed, but they need to be identified first.