Bench pressing planets with some fellow superheros the other day, we got-to-talking about how frustrating it is when one give's expert advice – like, 'That friendly face is mask, it hides a villain; don't trust him with your bank details', only to be ignored. Then the same person wants us to rescue their life savings from sailing away to a far away tax haven.

Doctors' advice gets ignored too sometimes. One of the reasons doctors are prescriptive in return to work (RTW) certificates is because they've had prior negative experiences. Most doctors know the frustration of clearing someone to return to work, only for them to be given duties outside the RTW plan. Sometimes it may occur soon after the person returns to work; on other occasions it occurs down the track when the person has been back at work for some time. The effects can be minor or major.

Why does this occur?

Well, in some cases employers are just belligerent, difficult and don't respect the workers needs. They might see restrictions as barely relevant. They simply get the person doing more work. While this is the minority of situations, it can colour doctors' views in all future situations.

It's more common that people are asked to work outside the agreed RTW plan over a period of time. Often this can occur when there is a rushed need to get a job done. For example, one worker might be on annual leave, then somebody calls in sick and there's an urgent need to get a job done by the end of the day. The worker is asked to help out and, being compliant, pitches in despite their RTW plan telling them they shouldn't.

How can a worker back at work deal with the difficult situation of needing to say 'no' when they feel they should be saying 'yes'?

It's hard to say no to people, particularly in a workplace. It's important to learn how to say 'no' in a way that maintains positive working relationships, but makes the issues clear. A Super Doc colleague of mine coaches people on how to say 'no' to tasks they aren't ready to undertake when returning to work. For example one way of saying 'no' might be “I'd really love to help you with this, but my doctor will be furious with me if I do it.” Another alternative is “I can't do that, but how about if I do this to help out?”

Getting people to take responsibility for their health problem is just as important as learning how to say 'no'. The RTW system can be so complex that people feel that they need to do as they're told. It's important to ground people in the knowledge that they have the condition, that they can receive advice from others, but that ultimately they need to be responsible for themselves.

Doctors don't write restrictions telling people what they can and can't do in the home. There might be some broad discussion about principles of management, but a doctor doesn't generally go through and write a strict prescription for what people can and can't do at home. This way patients make their own decisions, and of course they have flexibility in their home.

In the workplace it is best if people take ownership of their condition. In conjunction with ensuring that their restrictions are adhered to, it helps if people contribute positively to what they think they can do at work. Presenting a positive attitude tends to rub off on and makes others more willing to help.

More flexibility, partnership and communication at the workplace helps; support and coaching for the employee returning to work in ways to effectively communicate their situation is just as important...[Super Doc's train of thought is interrupted by his super hearing. “Help! Help!” Far away on Wall Street someone is screaming. “All my money! He's taken all my money!” In a flash Super Doc is gone, but not before rolling his eyes and muttering 'I told you so'..... The Anon Doc can fix anything, you just watch, the market will bottom / top out soon].