Clinical diagnoses unhelpful in getting sick staff back to work

Traditional diagnoses of illness are not helpful in getting sick staff back to work because they fail to recognise that many factors can cause ill health, Dr Max Henderson told delegates.

Employers, GPs and occupational health (OH) practitioners need to recognise the links between physical and mental health and should preface both with the words “so called”, said Henderson, who is a senior lecturer at the Institute of Psychiatry at Kings College, London.

The Med 3 sick note, due to be replaced in 2010, has been part of the problem. “Anyone who had the misfortune of having to deal with the Med 3 Certificates will realise what a mockery they are of any diagnostic tool at all,” said Henderson.

He said that a clinical diagnosis was often not helpful in explaining the symptoms that cause sickness absence. “It’s not cancer that takes you off work, it’s some of the symptoms that it brings – the physical diagnosis is not that helpful.”

He questioned the helpfulness of diagnoses such as work-related upper limb disorder or fibromyalgia, which were arrived at by vote in a committee.

While Parkinson’s disease, for example, is associated with occupational disfunction, the cause of absence is often not the motor symptoms of the disease, such as tremor or rigidity, but ‘softer and more nebulous’ psychological effects, such as depression and fatigue.

Subjective symptoms such as fatigue, pain, poor sleep and concentration problems are associated with sickness absence, but are common not only in people with physical disorders, but also those with psychological problems, or those with no disorders at all. However, subjective symptoms did affect the severity of symptoms and outcomes, said Henderson, citing research by Melamed et al on patients with hypertension. “The thing that took people off work was not whether they were hypertensive or not, but whether they were aware they were hypertensive.”

Other evidence showed that depression has an impact on cancer survival and life expectancy in general. “Depression itself kills you,” said Henderson.

Other problems with traditional diagnoses and sickness absence notification is that it fails to take into account co-morbidity when patients present with more than one complaint, as well as the social determinants of health.

Henderson contributed to Mental Health at Work, commissioned by the government’s Health Work and Wellbeing agency, and published in 2008 alongside Dame Carol Black’s review of health and work.


S Melamed et al, Hypertension and Sickness Absence – the Role of Perceived Symptoms, Journal of Behavioural Medicine, Vol 20, No. 5, October 1997

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