Sickness absence and Rehabilitation
In a survey of UK occupational physicians, commissioned by the Faculty
of Occupational Medicine (Agius et al, Occupational Medicine, 43:
February 1993), assessments regarding fitness
for work or sickness absence
ranked highest overall in the proportion of time physicians spent engaged
in them. This was true even after excluding pre-employment assessments
and "routine" health surveillance.
The following abridged proforma provides a guideline for auditing the
process whereby this clinical process is undertaken. How would you audit
the process and the outcome? Write your thoughts (don't cheat by reading
on just yet). Make a list of the sort of information you would expect to
be provided to you in most referral requests. Scroll down....
Recorded Referral Details
Does the referral:
Specify and quantify long term absence?
Specify whether the employee is still on sick leave?
Specify and quantify short term intermittent absences?
Specify another problem concerning performance or safety?
Include a relevant account of the employee's job/tasks, place and hours
Recorded Questions Posed and Relevant Responses
Current level of fitness for work
Likely date of return to work
Specific limitations in redeployment of the employee
Existence of any underlying medical conditions which may contribute to
unsatisfactory attendance, performance or safety
Likelihood of the employee to render regular and efficient service in the
Likely duration of any residual disability
Advice on whether work could be affecting the employee's health
Advice on rehabilitation
Outcome following Occupational Physician's Advice
Return to work in the time interval indicated
Implementation of physician's advice on redeployment and rehabilitation
Recurrence of original reason for referral.
Extending the audit of process
In the last example the focus of attention was the audit of the recorded
process of the occupational physician's assessment. This should be placed
in its proper context. Research has supported the anecdotal impression
that in some workplaces, the "weak link" in the management of sickness
and/or fitness to continue work lay with the identification by line manager
or personnel managers of the problems about which they needed medical advice.
Audit of process might therefore need to include a stratified random sampling
of sickness absences whether or not they were referred to the occupational
In what proportion of cases did the managers act on the
You may also wish to access companion pages on sickness
absence and on rehabilitation before
returning to this page.
medical advice .... about reporting of work related ill-health?
about steps for rehabilitation? ... (see also audit of outcome).
This page will shortly lead to the iterated version of the
author's Correspondence Assessment/Audit Tool in
Occupational Health (CATOH) .
This page is:
You may also wish to access the following URL:
Raymond Agius © Copyright
NOW.... Now consider carefully the clinical problems that you encounter.
Rank these starting with the ones you are consulted about most often. Look
more closely at the one or two commonest clinical problems. Can you be
more specific as to which relevant items in the history, physical examination
and advice you and your colleagues might deem to be important in the process
of your consultation? Which ones should be documented? Once you have written
your thoughts, then you may proceed to the next page.