The medical field, like every other, has a language of its own. Just watch any TV medical drama for an earful of the lingo (some more authentic than others) specific to health and medicine.

Some words, like ‘flag', can take on a particular meaning other than their everyday one.

Medically speaking, flags are markers of risk factors. They highlight and encourage medical practitioners to be aware of non-medical issues and support discussion about the management of common health complaints such as back pain and other musculoskeletal problems.

Flags aim to help care and rehabilitation providers identify the risk of disability in patients and pinpoint appropriate interventions to prevent it; and to assess how potential barriers to rehabilitation may be managed.

By highlighting non-medical issues that can impact a patient's outcomes, practitioners are encouraged to explore ‘flags' with their patients – that is, issues such as fear, beliefs, interpersonal dynamics and workplace matters. 

There are currently five flags: red, yellow, orange, blue and black.

Dr Garry Pearce, Rehabilitation Physician and former President of the Australasian Faculty of Rehabilitation, explains the differences:

“Red flags concern signs of serious pathology in patients with lower back pain that require urgent surgical opinion.” he said.

“Yellow flags, developed in New Zealand, cover mainly psychosocial barriers such as attitudes, beliefs, fears about the condition, and social factors of the injury.” said Mr Pearce. Such barriers inhibit rehabilitation and the likelihood of return to work successfully occurring.

“Blue flags relate to an individual's perception of work, such as low levels of support at work, poor job satisfaction, or excessive demands at work.  These factors can impede return to work." 

"The black flag denotes work conditions that could inhibit rehabilitation, such as lack of contact by the workplace, litigation, or lack of contact by the workplace."

Unfortunately the practitioners seeing patients with work related injuries don't always have a lot of time. Typically consultation time is around 10 to 15 minutes. Practitioners need to be able to address non-medical issues quickly and efficiently, with a clear understanding of the issues.

This requires simplicity and clarity, something the flag concept – alongside much industry-specific lingo – can't always claim to be. Those outside the medical world are excluded from taking meaning from the flag concept, as they aren't familiar with it.

The flag concept has served well in the ten years since its conception and has been useful facilitating the introduction of new concepts. Now that such concepts are no longer new, however, there is space for terminology that is more specific and clear, which address non-medical factors using a more inclusive language. We could relinquish terms such as ‘psychosocial factors' or ‘flags', and replace them with words that mean more to more people, such as beliefs and fears, workplace issues, blame, enthusiasm to return to work, past experiences and support from co-workers.