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Competency 2 – Good Clinical Care: Discuss the likely outcomes of any medical treatment or intervention on fitness for work.

Objective: to understand and manage the legal and ethical implications of advice on suitability for work

SKILLS:

Discuss the likely outcomes of any medical treatment or intervention on fitness for work.

This can be elicited by discussing the following scenarios or performing a role play:

Mr. X suffered a heart attack 4 weeks ago. He works as a manager of a small electronics factory and wants to return to work. He has requested your advice regarding this matter.
How would you proceed?

  • What factors would you need to consider?
  • What agencies could you contact for information?
  • Would your recommendation differ if he worked on an oil rig?

(Prompt : RTW following myocardial infarction is the norm. He should be encouraged to plan for a RTW in line with the evidence/consensus based RTW times as previously described. Consideration needs to be given to any symptoms, tiredness and medication including side effects. Consider how he will get to work i.e. his ability to drive, to do his job (does he need reduced phased hours initially? Should he do office work and not travel overseas for several weeks?

If there is no Occupational Health doctor or nurse then telephone advice on his management could be obtained form the doctors and nurses who work for the Employment Medical Advisory Service (EMAS) which is part of the Health and Safety Executive (HSE). If he worked offshore then he would need to comply with the fitness standards of the UK Offshore Oil Operators Association (UKOOA) and would need advice form one of their nominated doctors.

Mr. Y has recently been discharged from hospital following a fit. The letter from the hospital states epilepsy as the most likely diagnosis and has commenced Mr Y on medication. He works as a long distance lorry driver in a large company and has come to see you regarding his condition and returning to work.

  • What issues are raised?
  • Where can you obtain additional information?
  • When can he return to his job?
  • What are the options?

(Prompt: the key issues are around his fitness to drive and hold a licence to drive a lorry. Refer to the DVLA guidelines. He must inform DVLA of his condition. It is unlikely (very unlikely) he will be allowed to drive. Advice is needed on alternative work he can perform recognising that further fits may have a permanent impact on his employability. He may need to retrain. Help can be obtained from the Disability Employment Advisor (DEA) at the local Jobcentre. As he works in a large company relocation to a job not involving work at heights, near water or where there are risks should he lose consciousness maybe his best option.)

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