Sick-Note Britain: How Social Problems Became Medical Issues – ‘an important book that prompts serious consideration’

In his book Sick-Note Britain, Dr Adrian Massey makes the case for why doctors should be left out of sickness certification. OH advisor Libby Morley finds his arguments compelling.

Written in five sections that address sickness, certification, medicalisation, workplace and the law, and solutions (and with wonderfully entertaining sub-headings within each) this book is a must-read.

Whilst of particular interest to those working in occupational health, this book will stimulate and enlighten any reader. As I progressed through each section, I felt it raised more questions than (easy) answers; this was however enjoyable and offered a mental feast to digest!

“Measuring the Indescribable” provides an opportunity for the reader to consider how on earth can one objectively measure how a person feels and their ability to work. It asks if someone is deemed fit but could be harmed through working, should they work anyway?

The author describes the extent of sickness absence, the costs and the challenge of knowing for sure that a person’s inability to work is genuine. Certainty is easier in those cases where an obvious impairment exists, but what about the many cases where the symptoms are more subjective such as “feeling tired, pained (or) anxious”? There is scope for exaggeration in these instances and the option of taking advantage of the recompense provided by the state or the employer.

The scene is now set to dig a little deeper in the section entitled “Trench Warfare”. Here we are taken on a social journey from the times of “hunter-gatherer” and the very close community ties where everyone knew each other well and had no doubt about their neighbours need for support, and in the vein of reciprocity would do their bit to enable the whole community to thrive.

Then through industrialisation, automation and globalisation the responsibility for providing welfare in the event of sickness became the responsibility of either the state or the employer, and so required some way of checking and authorising the process.

Loss of trust

Trust is no longer possible as the relationship between the unwell and the (financial) saviour is largely an anonymised one. To satisfy the wider population, who are no longer close enough to be satisfied that a colleague is deserving, we now have to be reassured by a process run by “bureaucratic instruments” to govern the welfare state.

Doctors have become central to this process, possibly (as the author suggests) in an attempt for employers, employees and the state to shirk responsibility. Pages 47-48 provide an entertaining description of how ludicrous is the suggestion that a doctor is the best person to determine an employee’s fitness to work! You will enjoy this section entitled “Doctor Priests”!

The book continues to offer a useful history of welfare support over the decades, the moral hazards for doctors being relied upon to provide sick notes, people’s increased sense of entitlement, the pressures on the time of the GP, the fact that in most cases an underlying cause of illness is rarely found, the over-reliance by the legal system on medical assessment tools, the influence of our peers on how we ourselves feel and modern societies unhappiness.

This is an important book that prompts serious consideration of the many and varied angles it reaches. Employers, politicians, employees, GPs, occupational health advisors and probably Joe public would do well to read this!

Libby Morley is an occupational health nurse advisor and the owner of the Mindshift Consultancy

Sick-Note Britain: How Social Problems Became Medical Issues by Dr Adrian Massey is published by C Hurst and available now online and in bookshops

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