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Marnie Courage’s Blog About Doctors Notes Impeding RTW Outcomes

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What’s up Doc? Challenging the Validity of a Doctor’s Note

Working for an industrial manufacturing company, inherently brings with it higher physical demands and exposure to more risk factors than an office setting. With the increase in awareness of ergonomic and environmental risks, it is not surprising that these industrial workplaces are having to put more energy and resources into protecting the health and safety of their employees.

After meeting with the Safety and HR reps of a manufacturing company and hearing their frustrations with employees who bring in doctor’s notes and report they are no longer able to do their job for medical reasons, I am left bothered by the power of these scribbled notes. I know how easy it is for a patient to get a note from their physician to support their complaints or self determined limitations. I am also certain some physicians are writing these notes without knowing what are the physical demands of their patient’s jobs and are not providing qualitative assessment results to support the imposed restrictions.

I share the goals of the Safety and HR Reps in preventing injuries and promoting employee health, yet I am compelled to advocate for the employer to protect them from costs and headaches related to the malingering employee, who demonstrates poor employee engagement, is away sick frequently, and comes armed with doctor’s note, scribbled with questionable and vague restrictions.

How much value should the employer place in a doctor’s note that reads: “unable to perform job demands” or “no heavy lifting”, or “light duties only”, when the physician has not seen a Job Demands Analysis (JDA) to know what the physical demands of the job are and has not tested to see what the employee is capable of doing?

JDA’s provide information about the frequency, force and duration of these physical demands that would qualify any decision a physician could make about what is reasonable for their patient, but the majority of these doctor’s notes are being provided based on the patient’s request for a note to give HR or their manager.

Employers are left feeling helpless and usually attempt to accommodate the individual as best they can, but without the specific medical information as to what the employee is actually able to do, they are not adequately protecting the employee from further potential injury. So while the employee continues to be at risk, the employer is also at risk, for costs associated with the potential for future employee injury.

Here are some options for employers:

1. Have Job Demands Analysis conducted for the high risk jobs to identify the physical and cognitive demands of the job. The JDA can be used for writing better job descriptions, accommodating injured workers and used to in the Functional Capacity Evaluations(FCE) to determine if the employee can do the specific tasks safely.

2. Request from physicians more specific information regarding the notes they write to qualify the restrictions. Instead of challenging the physician’s opinion (OPC Inc recommends MD Notes no longer be used and accepted; that only your company’s MD Forms should be used & accepted) ask the Physician to fill out the Form about the medical diagnosis, prognosis and treatment plan, to assist in the job accommodation process.

3. Have Functional Capacity Evaluations conducted for any employee who claims they are “unable to do their job” or is returning to work after injury. The FCE is a clinical based, 2 half day, standardized assessment that measures the capabilities of an employee to assist with job matching and job accommodation. This is an evidence based tool for determining exactly what tasks the employee is able to do safely and provides recommendations for accommodations if and where required.

4. Develop a new Policy about the criteria for when and how FCE’s will be conducted and talk to the Union reps to ensure they are on board with these new procedures.

Protecting employees from injury is the priority of the  Therapist, physician, HR, Safety and Union reps and they all play a role in ensuring the injured worker is accommodated successfully. Caution should be given to those who rely solely on the doctor’s note for job accommodation and instead should use best practises to conduct assessments that provide qualitative and quantitative information. This data should include what an employee is able to do safely and what administrative, engineering and behavioural solutions are required. Are you up to the challenge?  Human Rights dictates you need to be. So, let’s get this process started.

Marnie Courage, OT Reg (MB)
OPC Sr Ergonomic Consultant

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