Introduction

This activity meets the criteria of the Massachusetts Board of Registration in Medicine for 1 credit of Risk Management Study.

Please check your individual state licensing board requirements before claiming these credits.

Primary Care physicians are often requested to provide information on a patient’s fitness to return to work following injury or illness. U.S. primary care physicians report that they are requested to provide opinions regarding work ability or "fitness for duty," on average, in up to 10% of all office visits. However, very little training is routinely offered in medical or postgraduate education pertaining to the health effects of work and assessing work readiness. Both generalists and specialists report that dealing with sickness certification and work ability can be problematic, including potential conflict of interest between their best medical judgment and what their patients desire. Education in a structured approach to fitness to work assessment method can enhance physicians’ knowledge about work fitness assessments as well as their confidence in performing assessments. 

Currently there are resources and guidelines available for physicians regarding work fitness such as the American Medical Association publication Guides to the Evaluation of Work Ability and Return to Work and the American College of Occupational and Environmental Medicine (ACOEM) guidelines on Preventing Needless Work Disability by Helping People Stay Employed . A simple but systematic approach to fitness to work assessments is offered in this module to help facilitate the evaluation process and increase the consistency of clinical decisions. Essential fitness to work definitions such as impairment or restrictions are explained and utilized in the module for familiarization with basic clinical concepts used in evaluation work fitness.

Meet The Author

Stefanos N. Kales

Stefanos N. Kales

Associate Professor of Medicine at Harvard Medical School

Dr. Kales is an Associate Professor of Medicine at Harvard Medical School, and Associate Professor & Director of the Occupational Medicine Residency at the Harvard School of Public Health. Dr. Kales is also the Medical Director of Employee Health & Industrial Medicine at the Cambridge Health Alliance, a Harvard-affiliated system of three hospitals. He is Board Certified in Internal Medicine and Occupational Medicine, and he has been elected as a Fellow of the American College of Physicians and the American College of Occupational and Environmental Medicine. Dr. Kales is on the editorial boards of Environmental Health Perspectives and the Archives of Environmental and Occupational Health. He has participated in a wide range of research, advisory and teaching activities on four continents resulting in numerous scientific publications. Dr. Kales’ group has provided seminal contributions in the clinical epidemiology of cardiovascular events in firefighters; including the first definitive statistical association of strenuous job tasks and on-duty cardiovascular deaths, which was subsequently confirmed in a later New England Journal of Medicine publication. Their work is influencing medical standards for firefighter’s fitness for duty, the need for improved wellness programs, better control of risk factors, and whether firefighters can safely return to work in the presence of significant coronary heart disease.

Chris Stewart-Patterson

Chris Stewart-Patterson

Dr. Stewart-Patterson has practiced Occupational Medicine since 1989. He provided occupational medical services to municipal Fire Rescue Services, RCMP, and Canadian Armed Forces among other organizations. His clinical practice includes frequently providing fitness to work assessments. He specializes in fitness to work evaluations for safety critical/sensitive occupations such as police, firefighters, correction officers, sheriffs and railway personnel. He frequently lectures both locally and internationally on medical and psychiatric disability evaluation including a series of lectures at Harvard Medical School Dubai Center. He is an instructor for the American College of Occupational and Environmental Medicine lecturing on assessment of disability and fitness to work. Dr Stewart-Patterson is a clinical instructor in the Faculty of Medicine, University of British Columbia.

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