Julie Holden would like nothing more than to see doctor’s notes for short-term absences confined to the dust bin of history.
And it’s not just the notoriously bad handwriting of medical professionals that Holden, a senior vice-president at SEB Benefits & HR Consulting Inc., has a problem with.
“Even if you could make out what’s written, I’ve seen plenty that just say: ‘Unable to work for two weeks.’ There’s no information on accommodations that employers could make or even anything that would help anyone understand how the employee might come back to work,” says Holden.
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“For many years, my advice has been to eliminate the use of a doctor’s note and replace it with some sort of functional abilities form,” she adds.
Several years ago, Britain provided a template to follow when it introduced so-called fit notes for absences due to sickness as a requirement for anyone missing more than a week of work consecutively. The system replaced sick notes dispensed by family doctors that focused on confirming that employees were “not fit for work” and the anticipated length of their incapacity.
‘A culture of sickness’
“There was a feeling that a culture of sickness absence was developing in the U.K., so the fit note was designed to be a philosophical change in the approach,” says Mark Gabbay, a professor of health services research at the University of Liverpool who has published a number of papers on the fit note. The fit note’s main innovation was to include a new check box for doctors indicating that an employee “may be fit for work.” When physicians pick that option, the intention is to trigger a discussion between the parties on what changes could help the employee return to work.
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“The idea is to focus on what you have the ability to do, rather than the disability,” says Gabbay. “You might not be able to work normally, but there are still some things you can do, maybe by altering your hours, working from home or making some other change to work conditions.”
However, results have been disappointing since the fit note’s introduction in 2010, according to Gabbay. In a 2014 study, he found doctors checked the new box on just 6.4 per cent of fit notes. In 2015, the British government added a Fit for Work program aimed at longer-term absenteeism, with research ongoing into its effectiveness.
Despite the mixed results, Vic Medland, the chief executive officer of the Ontario Teachers Insurance Plan, says he likes the idea of fit notes.
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“If you get improvements in early interventions and provide assistance, then you can make an impact on longer-term absences,” he says.
Holden notes employers with insured short-term disability plans are already familiar with some of the concepts, since insurers often require medical certificates for claims that include functional assessments of the employee. “Disability management has improved over the last few years. Historically, employees would go off work, and it could be weeks before employers had any idea about what was going on. That lag in communication means time is lost, while the employee is at home, potentially getting worse, without the help they need.”
Staying in touch
According to Holden, the rise in mental-health diagnoses has made keeping in touch with absent employees even more important.
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“Cognitive functional abilities are just as important to consider as physical ones, which is something that was largely missing from what we traditionally think of as the doctor’s note,” says Holden. “Early communication is key, but that doesn’t have to mean planning their return right that minute. You want to get lots of input from the employee, since they are the one who usually knows best what they can and can’t do.”
Michael McKiernan is a freelance writer based in St. Catharines, Ont.
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