- Faculty of Occupational Medicine - https://www.fom.ac.uk -

Competency 2 – Good Clinical Care:Be willing to seek advice and to change own views and to accept a patient can disagree with advice.

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


Be willing to seek advice and to change own views and to accept a patient can disagree with advice.

Decision making is a core clinical skill that can be very complex. It is not always possible to be aware of all the necessary information regarding various conditions and it is important to recognise one’s own limitations and seek further advice from appropriate bodies.

Recognise the need to take unpalatable or difficult decisions about ‘fitness for work’ issues.

On considering an individual’s fitness for work there will be times when you may disagree with the patient’s opinion of their capabilities. This can be very challenging and requires honest discussion and recognition of the implication of decisions made to both the individual and the doctor.

Be willing to accept that a diagnostic label does not reflect functional capacity.

It is important to individually assess a person in terms of their functional capacity; not all diabetics or epileptics are the same. Consider two individuals with epilepsy, one well controlled on medication who had their last fit 10 years ago, another who is poorly controlled with regular monthly fits. Both have the same diagnosis (epilepsy), but would have different working restrictions.

The above attitudes can be demonstrated by considering the following scenario:

Ms Y is a nurse working in a general medical ward of a NHS Trust hospital. She presents complaining that she is stressed, anxious and depressed as a result of her work. She has already had a week off for this reason (self certified), but says that if she had a further week away from work she would be better able to cope. Although unhappy at work, she is confident that she remains quite safe in the performance of her nursing duties. The GP’s assessment is that that she is not clinically depressed.

The type of information the GP should collect to help in the decision making process is outlined below:

1. Occupational information

a) Job Title:

Registered General Nurse

b) Occupational Tasks

2. Occupational satisfaction/concerns

Ms Y believes she is being treated unfairly at work. For example, she says that with regard to the duty roster her nurse colleagues were given first choice of hours, whereas she was told what hours she was doing. She says she thinks the nursing supervisor is showing favouritism to others. Ms Y says she feels she lacks understanding and support from both nursing colleagues and from management. She says she feels used and abused. She has already taken 7 days (self-certified) off work but says she can’t face going back into the workplace and wants further time off work.

3. Functional limitations in her job

Whether the claimant is incapable by reason of some specific disease or bodily or mental disablement of doing work which he could reasonably be expected to do in the course of the relevant occupation. Is there a medical condition? If so, does it constitute ‘mental disablement’? If so, does it cause the patient to be incapable of performing work tasks?

The GP then must make an evidence based approach as how to best manage the nurse. The options available are outlined below:

With reference to the above scenario:

Factors to be considered include:

The precise requirements of the job

The individual’s abilities in the working environment

The nature of any hazards (risk of harm occurring)

The probability of harm occurring (the actual risk in the workplace)

Who is at risk

Degree of risk: rely on facts available by means of