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Occupational health

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Occupational Health provides services to employers in many areas ranging from pre-placement medical assessments, ongoing health surveillance and assessments in high-risk activities and advice on reports in areas of poor attendance and sickness absence – to name a few. Writes Steve Malleson of Express Medicals

It is the last category where a medical report is provided by occupational health to assist management in dealing with a case where a health concern has impacted on either capability performance or attendance that I am addressing in this short article.

Over my years of practising Occupational Health (OH) the main complaints I have encountered from managers have been consistently in this last area of “management referrals” requiring an OH report. The recurrent complaints come into the following categories:

• “OH only regurgitates word for word what the candidate is telling them.”

• “They always take the side of the employee.”

• “They always sit on the fence and do not give us clear direc- tions.”

• “They do not answer the ques- tions we asked or required.”

• “They include inappropriate comments and advice.”

As an occupational health physician I of course would defend myself by saying that we obviously must take a history from the individual and therefore in a sense we do report what we’re being told. However, especially when there is acrimony, I would always qualify any information that is a direct statement from the employee with such statements as “told me that – etc.”

Also, so as there is no confusion I would add a statement to the effect “and although I cannot comment on the validity of the statement, this is clearly an area that should be addressed if an equitable solution is to be reached etc”. In this way the report should clearly state whether an opinion is subjective or objective.

I would never see myself as being simply “on the side of the employee” in the sense that I am not their advocate in the same way as their general practitioner. I would of course have a professional duty to ensure that I follow-up any referral and essential healthcare should I identify any undertreated medical problem although I would not get involved with their primary care which is outside the remit of Occupational Health. That is for the GP.

Occupational Health reports should be completely impartial with the object of giving the commissioning employer an overview of how any medical aspects may have impacted on the individual’s occupational performance without disclosing any confidential medical information.

Occupational Health reports certainly should not include comments and advice outside the strict remit of analysing and assessing the occupational health situation on the information given and questions raised in the referral documentation.

The value of clear and comprehensive management referral

The criticism of giving poor advice and not delivering the information by answering the questions asked is often a fault of poor management referrals. They often lack any useful information and do not give the assessing Occupational Physician any direction. As they say “garbage in/garbage out.”

A good management referral will give the background medical problems that are causing concern, why the individual is being referred to 0H, some specific questions that require answering and possibly an indication of why the employer requires this information.

It is also sometimes helpful for the Occupational Physician to understand the tactics being employed by management within the strategy, within the internal policy for an employment problem and how the 0H assessment can contribute to this end.

Points to include in the 0H referral.

Reports will differ as the circumstances will not all be the same. However, the following headings will always be considered by an occupational physician when composing their report to management and might also be valuable for managers when requesting specific areas to investigate and advise. They would come under the following headings:

  • Nature of underlying condition.(Without disclosing any specific confidential medical details – only on how it impacts on employment situation)
  • Whether there are any work- related aspects to the medical condition.
  • Prognosis/duration of medical problem.
  • Whether there will be any long- term residual disability.
  • Capability of regular and efficient service in the future with or without full efficiency or ill effects.
  • Risk of deterioration of condition.
  • Likely return to work date.
  • Limitation, restrictions, modifica- tions to duties either temporary or permanent with advice on any rehabilitation programme.
  • Suitability for alternative duties, timescales and whether surveil- lance is required after return to work.
  • Advice on whether the Equality Act 2010 may be applicable. Obvi- ously this is only medical advice on a legal matter which would be decided by other legal agencies if contested.
  • The value of a negative answer. • Medicine in some aspects is very imprecise and two people with an identical condition may react totally differently in terms of their response to their illness and the occupational implications.

Managers are sometimes disappointed that Occupational Health does not give very precise prognostic outlooks with the timescales. This should generally not be seen as a specific problem as the Manager having asked the question and not being given a very specific answer from 0H is then free to make a management decision based on the evidence available to them together with the operational business requirements and the manager’s own assessment of the likely outcome.

OH cannot always comment on what would be considered a reasonable period of absence as this will differ from company to company depending on such matters as their size, resources and services they deliver.


I hope this short article will be useful to any manager who makes referrals to OH for members of staff where there is concern in areas of health and performance and will take these points into account when both referring individuals and interpreting the reports that are returned.

I often say, without trying to be offensive, that the contract of employment for the individual is with their management (and not with Occupational Health) and therefore any employment decision is made by management.

Hopefully, Occupational Health can assist by giving an expert, impartial overview of the medical situation with an understanding of the implications on their employment situation as far as possible.

When this is not possible the report should clearly say so, thus allowing management to then move forward through their own procedures and processes having dealt with the situation fairly by asking the right questions.

Dr Steve Malleson MFOM, a senior occupational health physician, is the Chief Medical Officer of Express Medicals Ltd. www.expressmedicals.co.uk or call 020 7500 6900.


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