A list of five Choosing Wisely recommendations from the field of occupational medicine caught my attention the other day. For those of you who have never had the pleasure of working with a real live occupational therapist, they are under-appreciated healthcare professionals who help recuperating patients develop, recover, and improve practical skills they need for daily living. The goal of the Choosing Wisely campaign is to basically help reduce waste in the healthcare system and avoid patient risks associated with unnecessary treatment. It’s all good. But the part of this occupational medicine list from Choosing Wisely Canada that stopped me in my tracks was the first recommendation on this list:
At first blush, this recommendation seems to make sense. Doctors are urged not to approve time off from work following injury or illness unless medically indicated because “supporting absence from work creates disability which in turn negatively impacts health.”
The negative stereotypes such statements bring to mind include the lazy slobs stretched out on the couch eating Cheezies and watching daytime soaps on TV day after day, pretending to be sicker than they are just to get a free holiday from the stress of the workplace.
While it’s likely true that such slobs taking advantage of the “doctor’s note” do exist, what this recommendation from the Occupational Medical Specialists of Canada misses entirely is the reality for many of us diagnosed with chronic illness, and especially those living with an invisible illness (i.e. most of us).
It is a sweeping overstatement to claim that “supporting absence of work creates disability.” Being diagnosed with a chronic and progressive illness is what creates disability, not the absence of work.
After the first rush of welcoming hugs from my hospice colleagues, it soon became apparent to me (and worse, to them) that I was no longer able to function while juggling multiple deadlines, all due yesterday—the normal hair-on-fire pace in the world of PR. I’d enjoyed a high-profile and successful public relations career for over three decades in corporate, government and non-profit sectors – and being forced into early retirement in my fifties hadn’t ever been on my radar. I could scarcely believe that this is how my career would ultimately end a few weeks later, being sent home, weeping, in the back seat of a taxi, the last trip home I’d ever take from work.
The realization that I couldn’t continue working was devastating for me, mostly because I too had bought into the Choosing Wisely dictates that said “supporting absence of work contributes to declining health, slower recovery and disability.” I didn’t want to be that kind of patient. I didn’t want to be sick. I wanted and needed to go back to work to prove to myself and others that I was going to be “normal” once again.
Not all experts are fans of Choosing Wisely’s blanket recommendations. As the emergency medicine physician Dr. Marc-David Munk once explained to Prepared Patient® readers:
“Choosing Wisely is promoting itself as a means to ‘spark conversations between providers and patients.’ It has partnered with Consumer Reports to disseminate the list of overused and unindicated interventions to patients. There is a critical point to be made about Choosing Wisely and other campaigns, such as the World Health Organization’s and the U.S. Centers for Disease Control’s campaigns to improve provider hand washing: all expect consumers to carry the water when it comes to ensuring health care appropriateness.”
The trouble is, of course, that patients are often the least able to do this heavy lifting. Even trying to convince a physician to sign a request for time off work, for example, can be an overwhelming challenge for those who are living with illness or injury. That doctor wields the pen that can approve or deny that request – just like that. What if we can’t get that form signed? What will we do?
Being able to return to work after a serious cardiac event can hinge upon several factors.
Many heart patients recuperate uneventfully at home for a few weeks and are able to return happily to work with only limited restrictions, almost as if nothing’s happened. Some attempt a return-to-work trial as I did, but find it difficult or even impossible to keep up with the physical or mental demands required of the job. Depending on the severity of the heart condition, damage to heart muscle or valves, and ongoing cardiac issues, this may mean permanent retirement, a change to part-time employment, applying for a disability pension, or a significant career change to a much different occupation. These options are meant to preserve and protect health – not serve as some kind of public sign that “restoring working capacity” is the sole goal of recovery.
If you’re unsure, talk to your physician about the limitations your own diagnosis may have on your ability to return to work.*
* Read more about working (or not working) after a cardiac event in my book, A Woman’s Guide to Living With Heart Disease (Johns Hopkins University Press, November 2017).
Q: Have you ever experienced pressure to return to work faster than you felt was appropriate?
- How working – and not working – affects heart disease risk
- Handling the homecoming blues: the third stage of heart attack recovery
- Convalescence: the forgotten phase of illness recovery