According to Professor Gordon Waddell, co-author of a comprehensive UK review of the scientific evidence regarding the relationship between work and health, medical certificates are among “the most powerful, potentially dangerous treatments” in a GP’s cache.

Contrary to the common perception that work involves risk to mental and physical health, Professor Waddell’s research has led him to the firm conclusion that, in general, work is GOOD for health and wellbeing.

On the other hand: “Long term worklessness is one of the greatest risks to health in our society. It is more dangerous than the most dangerous jobs in the construction industry, or the North Sea, and too often we not only fail to protect our patients from worklessness, we sometimes actually push them into it, inadvertently…”
 
Inappropriate medical certification is one of the ways in which vulnerable individuals can be inadvertently pushed into long term work absence and disability. This fact sheet examines sickness certification practices in Australia, and offers advice for treating practitioners and employers.
 

The facts

• Annually in Australia:
  • More than 100,000 individuals develop health conditions that affect their performance at work;
  • Poor employee health and absenteeism cost businesses $7 billion; and
  • Sickness absence is estimated to cost 4% GDP, with healthcare running at around 8% GDP. 

• Sickness certificates provide the entry and exit points for access to health-related income support, including workers’ compensation.

• Over the past nine years, there has been a 70% increase in requests for sickness certificates in Australia, independent of industrial relations changes and without a corresponding rise in illness or injury. For the most part, these increases are driven by people with common health problems such as musculoskeletal disorders and mild to moderate mental health problems being certified as permanently unfit for work.

• In 2006, legislation was passed to grant 10 new categories of non-medical registered health professionals the authority to issue sickness certificates, even though there has been little in the way of research, guidelines or training for medical and allied health professionals to ensure appropriate sickness certification management. 

• Some medical conditions necessitate time off work. For example, a person recovering from surgery, an individual with a crush injury, someone experiencing debilitating pain or a person admitted to hospital, all require recovery time and may be unable to attend the workplace. 

• However, with many medical conditions there is a substantial discretionary element to work absence. By ‘discretionary element’ we mean that while the person has a health condition they are able to attend work if the right accommodations are made. In these instances, work absence is at the employee’s, or their doctor’s or employer’s discretion; there is no medical requirement that the employee stay away from work.

• In theory, medical certificates outline a person’s capacity for work based on their medical condition. However, in reality, certification is heavily influenced by many factors other than the medical condition, including the patient’s approach, the workplace situation, the availability of restricted duties and the overall way the system in the relevant jurisdiction operates. 

• Medical certificates influence patient beliefs, employer and system actions and, therefore, return to work outcomes.

Advice for treating practitioners

A well-informed treating practitioner has the capacity to educate both patients and employers about best practice return to work. Some patients and employers will have a good approach to return to work; others will not. Rather than passively accepting unhelpful ideas about disability, recovery and rehabilitation, practitioners should proactively seek to promote helpful beliefs and attitudes.  

The certification of work absences due to medically discretionary injuries and illnesses should be discouraged. Although GPs and other allied health professionals may feel that they are advocating on behalf of their patients by issuing discretionary certificates, in fact long term disability may be the end result.

Treating practitioners can influence the system by providing clear messages:

• Activity is an integral part of rehabilitation;
• Provision of modified duties fosters return to work;
• People are best off when they return to productive work in a supportive environment; and
• Return to work is more likely to be successful when undertaken early.

A number of barriers to return to work can be dismantled by:

• Changing beliefs and attitudes;
• Promoting patients’ understanding of the importance of being active; and
• Focusing on functional recovery rather than pain relief only.

Advice for employers

In order to discourage the provision of medically discretionary sick leave, employers should be flexible by:

• Making allowance for non-medical leave, as appropriate;
• Accommodating injured or ill workers in the workplace, for example by enabling employees to attend treatment sessions during work hours when necessary; and
• Providing a socially supportive, safe working environment.

Most of the facts referenced above are drawn from an article by Dr Debra Dunstan called "Are sickness certificates doing our patients harm?"