The Australian Medical Association’s Code of Ethics delineates the number one priority of the medical profession as follows: “Consider first the well-being of your patient.”

In the context of the workers’ compensation system, this simple statement of commitment to patient advocacy can seem fraught with complications.

Patients who have a work-related injury or illness may enter the consulting room feeling vulnerable and unsure about their condition and abilities. They may be anxious about their work situation. How will their supervisor deal with them? Will they be able to cope with the tasks they are assigned? Isn’t the stress of interacting with Colleague X only going to make recovery more difficult?

Patient worries about returning to work are common: less common are concerns about the potential negative consequences of absence from work.

However, evidence shows that being out of work for long periods is associated with:

• Increased rates of overall mortality, and specifically increased:
  • mortality from cardiovascular disease; and
  • suicide;
• Poorer general health;
• Poorer physical health, including increased rates of:
  • cardiovascular disease;
  • lung cancer; and
  • susceptibility to respiratory infections;
• Poorer mental health and psychological wellbeing;
• Somatic complaints;
• Long-standing illness;
• Disability; and
• Higher rates of medical consultation, medication consumption and hospital admission.

Dr David Beaumont, an NZ-based Occupational Physician, believes that GPs should approach issuing medical certificates for sickness absence in the same way that they approach issuing prescriptions for a course of medication. 

“No doctor would issue a prescription for a course of medication without considering the side effects, and discussing these with the patient.  ‘Prescribing’ time off work should be seen in just the same light – the conversation with the patient should include just the same kind of ‘risk’ discussions, and the same expectation that the ‘course’ of absence will be time-limited.”

Dr Max Kamien, Emeritus Professor of General Practice at the University of Western Australia, told Radio National’s science program Ockham’s Razor in 2001 that such risks should be discussed in terms that are meaningful to the patient.

Professor Kamien also said that, for best-practice GPs, patient advocacy comprises:

• Providing help in a personal or family crisis;
• Coordinating care, and helping patients navigate the health system;
• Working “minor bureaucratic miracles”, for example by helping accelerate a patient’s progression through a waiting list for surgery;
• Helping patients “make sense of the plethora of health information” available in the media / online;
• Taking a holistic view of health; and
• Facilitating a partnership approach to “the process of understanding and healing illness”.

Australian Occupational Physician, Dr Mary Wyatt, believes that there is an urgent need for such patient advocacy in the workers’ compensation arena.  

“Simple messages delivered in the clinical environment can encourage patients to develop evidence-based views of the relationship between health and work,” Dr Wyatt says.

Evidence-based messages include:

• “Work is an important part of rehabilitation.”
• “People off work often become isolated and depressed, and that is not what I want to see happen to you.”
• “Being off work is more detrimental to your health than smoking. Actually, it’s worse than smoking 200 (yep, 200) cigarettes a day.”
• “The longer you’re off work, the less chance you have of ever returning.”
• “Most common health conditions will not be cured by treatment.”
• “You’ll have some soreness in your back getting back to this job. But we need to get you going and the pain will improve as you get fitter. If we didn’t get people active after an injury we’d have no footie players in Australia.”
• “Typically, waiting for recovery delays recovery.”

Delivering such messages may not always be easy, however, in many cases the long term well-being of the patient demands it.

For more information about the relationship between health and work, see "Realising the health benefits of work," a position statement developed by the Australasian Faculty of Occupational and Environmental Medicine.