Absence in the Workplace Seminar 4th December 2012 in the Workplace Seminar 4th December 2012 ......
Transcript of Absence in the Workplace Seminar 4th December 2012 in the Workplace Seminar 4th December 2012 ......
Absence in the Workplace Seminar
4th December 2012
Dr Charlie Vivian
Consultant Occupational Physician / Medical Director
Biography
• Qualified at St Thomas’s Hospital, London
• Short Service Commission with RAF
• Qualified as GP
• GP in Swindon (2 years)
• Occ Med Training with Adastral Health
• Consultant, then Director of Clinical Governance, AHL
• NHS (Glos) from 2007-12, inc Director of Quality for
NHS Plus
• Corporate Health Medical Director 2012-
Topics
1. The YMCA
2. The Equality Act (previously DDA)
3. Reasonable Adjustments
4. Plateau Management
5. Motivation and denial
6. Low Back Pain
7. Stress
8. Conflict
9. Golden goose and Golden rule
Case 1: YMCA
• 33 year old Delivery Driver
• Goes off sick with severe depression
• Assessed by OH. Unwell, and unlikely to be better in
next 3-6 months.
• OH letter to manager confirms this
• Manager says he cannot wait, and opts for dismissal
• Patient then challenges the OH opinion
• What would you do?
The YMCA
• (Y)
• M. What is the true MEDICAL condition?
• C. Manager CONSULTS with employee
• A. Manager decides ADJUSTMENTS
The Equality Act (prev DDA)
• Purpose: to stop unfair discrimination
• Patient qualifies if condition has:
– Substantial
– Long-term impact on
– ADLs
• NB: consider off medication
Case 2: the EA
• 40 year old receptionist
• Has migraines every 6 weeks
• Severe, and result in 2 days of S/A every time
• Tried various treatments, but none have improved
• What would you do?
Reasonable Adjustments
• OH outline what adjustments you need to consider
• Management decide if these adjustments are reasonable
Case 3: Plateau Management
• 45 year old mechanic
• Heavy physical role
• Develops upper limb disorder
• Various treatment is provided
• Sees some improvement over time, but then reaches
plateau, and can’t do full job
• What would you do?
Plateau Management
Common Sense
• The funny thing about common sense is, there’s not
much of it about.
– Mark Twain
• The benefits of ‘experts’
Motivation
• With motivation, almost anything’s possible. Without it,
almost nothing is.
• Whether you think you can, or whether you think you
can’t, you’re probably right.
– Henry Ford
Case 3: low motivation
• 27 year old with chronic pain
• Blames company for causing the pain
• Off sick for 3 months
• OH assessment using MI:
– Confidence: 2/10
– Importance: 8/10
• Obstacles: heavy work, and conflict
• What would you do?
Case 4: Motivation & Denial
• 54 year old senior manager
• Has stroke, affecting speech part of brain
• Can’t speak (aphasia)
• Desperate to stay at work
• What would you do?
Case 5: Low Back Pain
• 39 year old warehouse operator, with lots of physical
activity
• Develops low back pain, and goes off sick
• Diagnosis is ‘degenerative discs’
• Various treatment (medication, physio) but symptoms
persist
• ADLs are restricted
• Are they fit to work? Is this work-related?
The value of investigations
Eg X-Rays and MRI scans for back pain
• There is no firm evidence for a causal relationship between radiographic findings and LBP. Weak association only for degeneration and LBP, and cannot be applied to individuals. (Van Tulder et al 1997)
• High prevalence of abnormal findings on MRI in normal asymptomatic subjects. Little relationship with past or present clinical symptoms. (Vingard & Nachemson 2000)
Aylward, [2]
Musculo-skeletal disorders
10 tenets of MSDs that are yet to be disproved:
• Abnormal to go without significant (ie ADLs) pain for:
– >2 yrs LBP
– >3 yrs Neck or Arm
– >5 years knee
• The majority of those with symptoms do not medicalise
• Patients with LBP have a surrogate complaint (ie they can’t cope)
• Mild degeneration of MSD is normal
• PIVD hypothesis is wrong for axial pain, and marginal for radicular
Hadler, [3]
Musculo-skeletal disorders
• 10 tenets, cont – Most knee joints with pathology don’t hurt. Most joints that
hurt don’t have pathology – All treatment for LBP is ineffective, including surgery and
medication. – We don’t know what causes regional MSDs. To label as
injury is no better than labelling a spontaneous headache as injury
– Discectomy 2/12 quicker recovery than no treatment – (Sarno) Acute PIVD settles in 1-2/52. No validation for
surgery
• People become patients when they have exhausted their wherewithal to cope. Months/years of investigations and Rx could be avoided by directly addressing the coping challenge
Hadler, [3]
The failure of health and safety
From Burton K
Case 6: stress
• 34-year old administrator
• 3rd child is not very well
• Elderly relatives
• Financial worries
• Colleague at work off sick long-term
• Has argument with manager, and goes off sick. GP note
says ‘work-related stress.’
• What would you do?
Defining Stress
Tasks Capability
The Pint Pot Theory
The Myth of Positive Stress
Bored
V-max
Broken
Stressed Optimal
Conflict
• Win
• Avoid
• Give in
• Persuade
• Resolve (win-win)
From Killman
Bully
Victim
Victim
Bully
Outcomes from Conflict
Mgr Employee
WIN - LOSE
LOSE - WIN
LOSE - LOSE
WIN - WIN
NO DEAL
Golden Goose
• Once upon a time there was a goose that laid a golden
egg…
– From 7 Habits of Highly Effective People (Stephen
Covey)
The Golden Rule
• Do to others as you would have them do to you…
Discussion & Cases