Long term sickness absence: General practitioners have crucial role but need political supportBMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7499.1087-c (Published 05 May 2005) Cite this as: BMJ 2005;330:1087
EDITOR—I believe that general practitioners, with their records and knowledge of these common conditions, are in the best position to make decisions on absence from work.1 However, the system needs to change to reflect the greyness of most of these decisions. In some conditions there are no issues about absence—for example, severe angina. However, in many conditions prompting a review of the fitness to work, the clarity of the need to refrain can vary from reasonable to dubious/not indicated. These descriptions would change depending on how long the patient has been off work already.
Is there some way the general practitioner could indicate that status which would allow the employer or the benefits agency to add their opinion and even make the decision? The general practitioner can give an opinion that it is not clear whether the patient should work and whether working is unlikely to seriously impair the patient's health and then the employer or the benefits agency could use their knowledge of the job or jobs available to make a decision.
We need a more sophisticated system that retains decisiveness and speed. We need a system that does not put someone who is blind and has had both legs amputated in the same group as a young man with mild chronic depression. That system also needs to use the general practitioner's skills and knowledge in a way that does not threaten the general practitioner's therapeutic relationship with the patient.
Competing interests None declared