Return to work is not possible for everyone, but certifying time off work, particularly when absence is long term, can have significant impacts, including poorer physical and mental health    .
Returning to, and recovering at work is often in a patient's best interests, both for their quality of life, and their family's.
Using evidence-based messages
Evidence-based messages include:
- Work is an important part of rehabilitation
- The longer someone is off work, the less chance they have of ever returning
- Most common health conditions will not be ‘cured’ by treatment
- Work is a therapeutic intervention, it is part of treatment
- Even when work is uncomfortable or difficult, it usually does not cause lasting damage
- Typically, waiting for recovery delays recovery
- Staying away from work may lead to depression, isolation and poorer physical and mental health
- Employer-supported, early return to work helps recovery, prevents deconditioning and helps provide patients with appropriate social contacts and support mechanisms.
Practical steps for helping patients return to work
Practical ways of assisting patients back to employment and optimum functioning include:
- Recommending a graduated increase in activity and setting a timeline for return to work
- Talking to the employer (preferably while the patient is with you), especially about how to modify the workplace and work duties to allow return to work
- Collaboratively identifying obstacles – and solutions – in the workplace
- Being clear about what health care can and can’t achieve, and
- Identifying possible sources of support, including family members, co-workers and relevant government services.
The health benefits of good work
The Health Benefits of Good Work is an initiative of the Australasian Faculty of Occupational and Environmental Medicine and recognises that there is compelling international and Australasian evidence that work is generally good for health and wellbeing, and that long-term work absence, work disability and unemployment generally have a negative impact on health and wellbeing.
International evidence has shown that:
- Returning to work is therapeutic and promotes recovery.
- Returning to work is good for patients physically, socially and financially.
- Time off work is often not medically necessary and can delay recovery.
- Patients don’t have to be 100% fit before they return to work.
- Return to work is more than twice as likely if guidance is given on how to prevent recurrence and re-injury.
- Patients are more than three times as likely to return to work soon after injury if their health professional gives them a date to return to work.
- Long-term work absence, work disability, and unemployment has a negative impact on health and wellbeing.
Focusing on what capacity a patient has at work (rather than what they can’t do) should assist with return to work.
Starting the conversation
Talking with your patient about recovering at work can be difficult. It’s best to set the tone from the first conversation by focussing on what the patient can do, rather than what they can’t.
Consider the talking points below to help influence your patient’s perception of their capacity of work and help them “get back on the HORSE”:
The HORSE framework is a way to manage conversations when patients experience complex psychological barriers preventing them from returning to work.
By keeping the conversation focused on actions and outcomes, patients may be more receptive to discussions about ‘getting back on the horse’:
Hurdles: What’s stopping you from going back to work?
Optimism: Let’s focus on what you can do rather than what you can’t.
Rewards: Getting back to work will benefit you financially, socially and psychologically.
Schedule: Let’s agree on a time frame for getting you back to work with appropriate duties and hours.
Expectations: What are your expectations of returning to work? What are your employer’s expectations?
 Mathers C, Schofield D. The health consequences of unemployment: the evidence. Med JAust 1998;168:178‐82.
 Platt S. Unemployment and suicidal behaviour: a review of the literature. Soc Sci Med1984;19:93‐115.
 Lynge E. Unemployment and cancer: a literature review. IARC Sci Publ 1997:343‐51.
 Brenner H, Mooney A. Unemployment and health in the context of economic change. SocialScience & Medicine 1983;17:13.
 Kosny A, Franche RL, Pole J, Krause N, Côté P, Mustard C. Early healthcare provider communication with patients and their workplace following a lost-time claim for an occupational musculoskeletal injury. Journal of Occupational Rehabilitation. 2006. 16(1):27-39.
 The Australasian Faculty of Occupational & Environmental Med. Realising the Health Benefits of Work. The Australasian Faculty of Occupational & Environmental Medicine. 2011.
 The Australasian Faculty of Occupational & Environmental Med. Realising the Health Benefits of Work. The Australasian Faculty of Occupational & Environmental Medicine. 2011. View online