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Competency 2 – Good Clinical Care: Access evidence based return to work times

Objective: to understand and manage the legal and ethical implications of advice on suitability for work

SKILLS

Access evidence based return to work times

Certifying doctors or medical practitioners need to review clinical management options and consider a final (return to work) certificate at every consultation with a patient who is being advised to refrain from work.

Evidence based recovery times may help doctors in determining a reasonable period of time to refrain from work. The information in the table below provides indicative recovery periods in relation to four common operative procedures as well as cardiac illness. It is based on up to date evidence from a large number of clinical trials.

The information applies to general fitness to work for people below 60 years of age without other significant disability and working in all occupations other than heavy manual work. In some occupations safety related medical standards have to be met after a cardiac illness*. It is worth noting that the presence of other disease (e.g. diabetes mellitus) rarely prolongs the period of recovery following these procedures.

Certifying doctors or medical practitioners should consider this evidence when advising their patients of working age.

Postoperative time to full activity including work [weeks]
Operation Laparoscopic Open
Abdominal/groin hernia 1-2 2-3
Appendectomy 1-2 2-3
Cholecystectomy 2-3 3-5
Hysterectomy Lap. assisted vaginal Abdominal
3 7
Cardiac illness Angioplasty Infarction CABG
0-4 4-6 4-8

*For example the DVLA requirements for Group 2 license holders set out in ‘At a Glance Guide to the Current Medical Standards of Fitness to Drive’. Specific medical safety standards also exist for certain jobs in the transport industries including railways, shipping, airlines, diving etc.

Case Scenarios

To illustrate the concepts and issues raised in the knowledge section consider the following scenarios:

      1. Mr X. is a 38 year old Primary School teacher who has a history of low back pain and has recently experienced a reoccurrence. The pain is moderately under control with analgesia but he has increasing discomfort if sitting for longer than 30 minutes and feels unable to cope with the physical demands of his job, which include teaching physical education.
        He has visited the GP requesting a sick note following the initial 7 days of self certification (absence), and is provided with a certificate for 2 weeks.
      2. Mr Y. is a 39 year old self employed accountant who has a history of back pain and has recently experienced a reoccurrence. The pain is bearable with regular analgesia. He visits the GP for advice regarding his back. Following discussions he returns to work in a limited capacity, delegating some of the work to other members of his workforce; coming in for the morning only, with gradual increase to full time work over a 3 week period.

Both Mr. X and Mr. Y. had the same clinical complaint yet one did not return to work for at least 3 weeks, and the other remained in work on initial reduced duties.

So what might lead to the difference in their management?
Employment status: The teacher would be paid SSP, whilst the self employed accountant would get no money if off work.
Job Control: The accountant is able to modify his own duties and hours to suit his clinical needs. The teacher is managed by a line manager who may not have the resources to provide for such adjustments.