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Hi Alan and all, My hand is well and truly up - I recently wrote to an employees GP, Psychologist and psychiatrist. We were trying to return him to work following a relapse with paranoid psychosis. I forwarded the letter to all outlining my understanding of the condition, treatment and progress and offered a suggested return to work plan, also asked if there was anything else I should be aware of. Only the psychiatrist wrote back and was positive. Understandably she was the clinician repsonsible for his care so that fact that nothing came back from his GP is understandable. She contacted me directly again today - due to further relapse - and we discussed the best way to get him back to work - it pays dividends - its called good olde fashioned team work. Not always positive when you try to work in a 'community partnership' way - but we really need to try.....don't we?? Fiona ----- Original Message ----- From: Alan To: [log in to unmask] Sent: Thursday, January 22, 2009 10:34 PM Subject: Re: [OCC-HEALTH] sick certificates Hi Carr Challenging the GP is probably not constructive, and Sharon, I thought your attachment was a bit inflammatory - for instance Many GPs believe their role is to act as the patient's advocate. - the GP is and always has been the patient's advocate. Getting them back to work is part of that, but sometimes we consider other, non-work issues that are stopping them working. Sharon's document also says I'm doing 1 or 2 Med4 forms per month. If I do 4 per year, I'd say that's been a heavy use of that pad of forms. I think I'm the only doctor (out of 7 plus a GP registrar) who even knows where the pad of Med4 lives. It also says that The two-week restriction on specifying a date of return to work in a closed certificate can mean that patients need a further GP appointment just to obtain a certificate but of course that's nonsense as I can issue a Med5 without having to see the patient again if they ring in and say that they re fit. Given that there are good OHPs and bad OHPs ( I've worked with both) and good GPs and bad GPs (ditto, some years ago I had to sack my senior partner), you could consider sending the GP a suggested return to work plan - hands up those of you who have tried this in the last year! I'd expect that a sensible GP would be happy to look at it, discuss with the patient and help them get back to work that way.... although I'd probably (with my GP hat on) say that this should be OH's role, and if OH can agree a RTW program with the patient, he/she could then come back to the GP and say "'I'm fit for work, starting Monday on reduced hours, can I have a Med3 saying that I am fit to go back to work" The much-heralded "fit notes" will be great - provided the GP gets accurate information about what the job entails. A recent problem I had was where a man employed as post room/porter said to me that he can't work because it's up and down stairs all the time, I had to take it on face value. As it was my OH job, I spoke to the line manager who gave me a very different job description. ... had I been wearing my GP hat, I would have had to taken the patient's word. A counsellor once told me that one has to work with whatever reality the client/patient brings with them, and there's no doubt that the patient only tells me what they want me to know. A GP's mind-set with Med3 and Med5 forms has always been that someone is either totally fit for their job or totally unfit, and this will be hard to change, even for those of us with OH interests. I will try harder, I promise. TATT ( tired all the time) is a very reasonable label and we do use it but hopefully not too often. You have all have had it when you have just got over the flu ( real flu, not just a bad cold), the fever has gone and you are just exhausted. Causes include post-viral debility, "asthenia", ME, Chronic fatigue syndrome ( once you've had it for 6 months, what label would you like before the diagnostic criterion have been reached? ), glandular fever, inflammatory conditions like rheumatoid arthritis, depression and stress. I know you've all come across people with severe depression who complain that they are exhausted the whole time. A lunchtime meeting would be an amazing opportunity to meet the local employers. However, I think that the last time I got to a lunchtime meeting was about 3 years ago. Lunch is usually at my desk ( but away from the keyboard, obviously) or if I'm really lucky I get 5 minutes upstairs in the coffee room. There just aren't enough hours in the day any more - I'm not asking for sympathy, all the Daily Mail readers out there know that I earn £ squillions - but time at lunchtime is spent reviewing prescription requests, dealing with queries, ringing patients, chasing the hospital etc etc. Last week I got a result from the hospital on an X-ray that was taken in May 2007! "Stress" as a label is also a problem one... I last used it for a man who had to take time off to care for his demented mother. The man was perfectly physically and mentally fit, but worn out by getting his mother to the toilet 6 times per night, cleaning her up when her bowel control lapsed, feeding her before the carers came in at 9 for an hour to dress her and wash her, before they disappeared, stopping her wandering during the day and taking her to the toilet before she was incontinent again. With our aging population ( and inadequate overstretched social care services), it's an increasingly common scenario - see http://nhsblogdoc.blogspot.com/2009/01/carers-conundrum.html for someone else's view on the subject. What else would you prefer on the Med3? "Maternal dementia" - a breach of medical confidence as the employer has no right to the diagnosis of a third party , "filial duty" ? Sorry of this is a bit of a rant, today has been more poo than most Alan ~~~~~~~~~~~~~~~ Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH OCCUPATIONAL HEALTH JOBS http://OHJobs.drmaze.net OCCUPATIONAL HEALTH NURSING EDUCATION http://www.aohne.org.uk ~~~~~~~~~~~~~~~ Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH OCCUPATIONAL HEALTH JOBS http://OHJobs.drmaze.net OCCUPATIONAL HEALTH NURSING EDUCATION http://www.aohne.org.uk