Competency 2 – Good Clinical Care: Analyse and synthesise the interaction between clinical and medico-legal aspects of work and health
Objective: to understand and manage the legal and ethical implications of advice on suitability for work
SKILLS:
Analyse and synthesise the interaction between clinical and medico-legal aspects of work and health
This can best be demonstrated by means of a case discussion.
Case: Cancer and return to work
Consider an individual who has been diagnosed with cancer and the implications this has to their employment. The number of patients who live for five years or more after diagnosis and treatment of cancer has increased substantially in recent decades. Many have a reasonable prospect of returning to work but do not do so. This can cause them to suffer serious financial and psychological difficulties.
For the purposes of this discussion we will assume that most of these survivors who were working in or away from home before their diagnosis wish to remain at work or return to work as soon as possible after treatment. Our aim is to decide what their doctors might do to assist them to minimise their absence.
- What factors might impede return to work by a cancer survivor?
- How might you and others contribute to high quality occupational rehabilitation for cancer survivors under your medical care?
- What changes might have to be made at or around work to allow the patient to return?
- Are there any legal requirements on the employer to make adjustments to such individuals?
- Most workplaces have no occupational health staff. How might effective vocational rehabilitation be achieved in these circumstances?
- What performance indicators might be useful in measuring the quality of your contribution to the management of return to work of cancer survivors?
Possible answers/points to raise:
What factors might impede return to work by a cancer survivor?
- Disease related examples:
- Burden of treatment
- Advanced disease stage
- Person related:
- Fatigue
- Pain
- Lack of concentration
- Lack of self confidence
- Fear
- Work related:
- Physical demands
- Difficult relations with colleagues and superiors
How might you and others contribute to high quality occupational rehabilitation for cancer survivors under your medical care?
- Attending physicians and family doctors should pay attention to the prospect of work from the outset, fostering appropriate expectations of resumption of work after treatment of the cancer is finished and possibly during treatment.
- General practice and occupational health doctors and nurses should have a good knowledge of cancer and cancer treatments and understand the local practices and arrangements.
- The occupational therapist should be involved.
- Ensure there is good communication from the outset between healthcare staff in hospital, the general practice and the workplace. This contact should increase as recovery progresses and opportunities present or are created to seek to work with the employer to make whatever changes your patient and you agree would assist return to work.
- If the patient is to return to caring for the family at home or other work at home there may be a need to make changes.
What changes might have to be made at and around work to allow the patient to return?
Whatever reasonable changes the patient thinks necessary and which the employer is willing to provide. These might include:
- A gradual return to work e.g. mornings only for the first few weeks gradually building up to usual hours
- Increase of autonomy, ability to get up and move around to ease discomfort
- Decrease of workload, reallocation of tasks involving physical work
- Adaptation of workplace processes, methods and welfare arrangements
- Education of work colleagues and superiors
- Adaptation of car to allow travel to work
Are there any legal requirements on the employer to make reasonable adjustments to such individuals?
Individuals with a diagnosis of cancer ( or multiple sclerosis or HIV/AIDS) are now covered by the Disability Discrimination Act (DDA) from the point of diagnosis and even if they do not have impaired day to day activities.
As such the employer has a legal duty to provide reasonable adjustments. This can include
- Alteration of duties
- Adjustments to premises
- Changes to equipment
- Reduction or flexible hours
- Gradual reintroduction to the work place
- Job transfer
- Time off for treatment
- Additional support for example another employee is assigned as a buddy who can supervise and support an individual retuning to work
Most workplaces have no occupational health staff. How might effective vocational rehabilitation be achieved in these circumstances?
- General practice team might intervene with the workplace
- NHS Plus staff
- Outreach by NHS rehabilitation staff
- Occupational therapists
- Work psychologists in local Department of Work and Pensions
What performance indicators might be useful in measuring the quality of your contribution to the management of return to work of cancer survivors?
Particular criteria to be met should be defined in respect of:
- Medical knowledge of the disease process and treatment of the patient.
- Continuity of care through good communication and integration.
- Necessary and effective interventions:
- for disease related complaints
- for personal factors
- to improve relations at work
