JISCMail - OCC-HEALTH Archives

Although I know Sharon was playing devils advocate I must admit I actually land on the stance she takes in that it comes down to what the customer has asked you to advise on i.e absence patterns and the prognosis for future attendance patterns.

So I would tend to take it back to basics and look at the fundamental questions.

Is there a diagnosed medical condition that is adversely affecting ability to attend? If yes why is treatment not correcting that disability? Can this be improved with a review of medical treatment or is it medical treatment at it's optimum?

If not diagnosed medical condition is there strong evidence to suggest a medical condition (any other symptoms, impairment around the current situational issue)? If so what is the likelihood of the issue being resolved by medical treatment taking into account employee's reported beliefs about the role of western medical treatment and his pastoral beliefs.

In cases such as this my reports tend to be "MR x describes disturbed sleep patterns which he believes affect quality of his sleep affecting his ability to attend work. He is not under any medical treatment nor does he plan to seek any. There is no evidence of any diagnosed medical issues. I have advised him that he may benefit from discussing his symptoms with his GP as this may help him promote his wellbeing and improve his attendance however attendance with the GP will ultimately be up to MR x. In the absence of any significant change to circumstances there is unlikely to be any significant change attendance patterns."

etc etc

Carr

On 29 January 2013 05:42, Tracy Turner <[log in to unmask]> wrote:

Hi. Just a thought but have you asked him directly if there is any substance miss use?? Tracy
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From: sharon naylor <[log in to unmask]>
Sender: [log in to unmask]
Date: Mon, 28 Jan 2013 22:12:13 +0000
To: <[log in to unmask]>
ReplyTo: Occupational Health mailing list <[log in to unmask]>
Subject: Re: [OCC-HEALTH] hallucinations-Hypnagogic ?

Devils advocate time. The back story to this (bearing in mind recent posts re referrals etc)may be......... What is it that we in OH are trying to achieve? Are we there to inform management as per their referral or are we trying to unravel a medical (or otherwise) conundrem? Where are our boundaries, is this within our remit? Are we there/here to discover hitherto unavailable diagnoses? Are we trying to be all things to all (wo)men? I dont know the answers by the way - just an observation. Its all too easy to get side tracked by a complex case, I do it often, and also by our desire to "do something". Yet sometimes it is apparent that there is little that we can do without blurring our own professional parameters.

In this case - your chap had DNA`d twice. Some OH providers wouldnt have made the third appointment. And then he was late so you couldnt make a proper assessment. There would be some that would say "Dont bother any more, then" but then the rest of us would be trying to find a solution, a reason, even though all the early indications are that the individual isnt that interested (for valid reasons from his perspective) in our opinions. Do we need a line in our professional sand, for when enough is enough? I have a couple of cases within my dept at the mo where the OHAs are trying to contact/make appointments for people who clearly have no intention of engaging and DNA for every single meeting. Which bit of this is an OH rather than a management issue? Please note, I am not saying that anyone is wrong, but it is an example of how complex the OHA role has become

Date: Mon, 28 Jan 2013 21:50:08 +0000
From: [log in to unmask]
Subject: Re: [OCC-HEALTH] hallucinations-Hypnagogic ?
To: [log in to unmask]

Lynne,

I know this may sound short but did you discuss his frequent absences and the reasons for absence whether health or otherwise? (I note you were short for time)

I am tempted to say that he could have been deflecting from the problem e.g. DNAs initially then he attended with this complex story. That said when I have been presented by a complex history and presentation ....they have always been quite poorly and eventually the situation unravells with significant psychiatric diagnosis.

You may well be right and short of referring to GP and an OHP you are limited in how you can help.

Kate

From: SUBSCRIBE OCC-HEALTH Lynne Whitmore <[log in to unmask]>
To: [log in to unmask]
Sent: Monday, 28 January 2013, 20:55
Subject: [OCC-HEALTH] hallucinations-Hypnagogic ?

Dear list

I would appreciate any advice on this matter .

I have seen a young man today as a management referral for frequent abscences. The young chap has reported' sleep problems.' He has recently changed from night shifts to rotating shifts consisting of earlies and lates . He requested to move from nights for a variety of reasons stating that he was finding nights difficult and that it was impacting on his social and family life . On further discussion the following unfolded.

He reports that things have greatly improved for him since moving from nights. On questioning him about sleep hygiene ,lifestyle ,mood etc . He reported feeling low in mood and has been experiencing hallucinations whilst in a' paralysed' state whilst he is just going off to sleep .He reports seeing' dirty squirrels' and' people.' On general questioning he reports that this has been going on for a year, but he did not wish to report it .He denies any auditory hallucinations and is clear that hs hallcinations only happens before sleep. I have advised him to seek medical advice for underlying causes ,however he states that he does not view it as a medical issue but a spiritual one . He also reports that he feels his spirit is leaving his body . He states that his church and his spiritual advisor have advised him not to consult with the medical profession as we would not understand. His facial expressions concerned me as he kept narrowing his eyes to almost shut then widening themevery few minutes . I am of the opinion this young man has had unreported sleep issues for some time. He denies any previous medical problems .

He feels that praying and spiritual guidance are the answer and does not appear to be convinced otherwise to seek medical advice to explore this issue appropriately .

I am unsure if he is fearful of a particular diagnosis but have reassured him that there is a possibility of an underlying issue to explain and treat these symptoms .

As the chap was forty minutes late our appointment was shorter than usual. He had DNA'd twice. I have arranged to see him again this week to follow up on a GP appoint that I hope he has attended on my advice .

I m not sure where to go from here so would appreciate your valued experieces and advice .

Kind regards

Lynne

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