Assessment of fitness to work

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Doctors play a key role in helping a worker return to work. An important part of a doctor’s role is assessment of fitness to work and to certification of a patient’s capacity for work. Certifying capacity for work promotes a positive return to work message for the patient and if focused on assessing a patient’s capacity to work, rather than their incapacity.

The key steps in assessing fitness to work and development of return to work plan include:

1. Assessment including:

  • History
  • Examination – focus on addressing physical consequences of cancer diagnosis and treatment
  • Psychological issues – especially anxiety and depression and motivational factors
  • Social factors including family support, attitudes of co-workers and employer and social security, insurance and superannuation issues.
  • An understanding of the work demands is important to facilitate a return to work

2. Management including:

  • Communication –Early, with active participation of the patient and employer
  • Certification, including activity and return to work advice
  • Explanation and reassurance
  • Return to work plan and plan for further treatment including allowance for time for ongoing medical appointments etc.
  • Emphasize physical reconditioning and treatment of any identified psychological barriers

3. Implementation of a stepped care approach with review of progress against expectations

  • Apply simple low intensity measures with progressive stepping up of hours and duties

4. Further/follow up assessments including:

  • Understanding the worker’s perceptions about their disease, its prognosis and their own capacity for work
  • Physical and psychological progress issues following a partial resumption of work activities
  • Workplace environmental, psychosocial and personal factors which may have emerged

5. Modification of the management plan and assessment approach depending on progress:

  • Ongoing communication at the work place can positively influence early outcomes and identify relevant issues
  • Actively managing a return to work process with a practical problem solving framework can enhance early return to work and facilitate progressive improvement
  • Identifying and actively managing risk factors associated with poor outcomes can assist with return to work

6. Input from other professionals as needed.

Want to know more?

Here is some helpful reading on assessment of fitness to work.

  1. Fitness for Work – The Medical Aspects.  Fifth Edition Edited by Keith T Palmer, Ian Brown, and John Hobson Oxford University Press ISBN: 9780199643240. This is a very useful text for all practitioners interested in the subject
  2. AMA Guide Work Ability and Return to work 2nd edition. James B Talmage  J Mark Melhorn Mark H Hyman ISBN-13: 978-1603595308 This US text includes a chapter specifically on oncology.
  3. Austroads. Assessing fitness to drive  – commercial and private vehicles. This publications assists in decision making around the sometimes difficult issues of driving and health.

In addition, the following online resources may be useful:

The Institute for Safety, Compensation and Recovery Research has recently conducted a research forum on the role of general practitioners in return to work. While not specifically focused on cancer, the information presented may assist GPs in supporting patients with cancer. To view the video recordings of the presentations click here.

The McMillan Cancer Support in UK offers a learning opportunity for GPs through their Learning Zone – it is free but requires registration. Go to e-learning and videos and look for Working with Cancer course.

The South Australian Postgraduate Medical Education Association offers online learning on return to work. To register click here.

UP: Develop a strategy for work after cancer