Who are you and what do you do for a living?

It was a dangerous time to be a forklift driver. One day I saw four of them each reported gastroenteritis. Now recovering but not fit to go to work. Or so they said. They were not related in any way, not even working in the same place and each had been poisoned by their spouse with something different: pizza, meat pies or lasagne. So either the partners of forklift drivers were terrible cooks or there was something else going on.

In April Wynne-Jones and Dunn reported data on sickness certification in the UK in the BMJ open. Their conclusion caught my eye:

Rates of sickness certification for back pain demonstrated a downward trend between 2000 and 2010. While the reasons for this are not transparent, it may be related to changing beliefs around working with back pain.

They try to explain their findings but then point out the main deficiency of their research:

This data set is based in one area of the UK, North Staffordshire, and it could be argued that it is not generalisable to the rest of the population. Previous work with this data set has demonstrated that crude rates of certification change very little when the data are standardised to the age and gender of the population as a whole, and there is no indication that this should be any different for this study

I scoured the paper for what might explain the findings because I couldn’t accept their thesis. I didn’t find what I was looking for. So I searched the unemployment statistics for the West Midlands in the UK dataset. As it happens the unemployment rate in that part of the UK, which includes Staffordshire varies quite significantly from the rest of the UK. When you plot the unemployment rates versus sick certification for low back pain the picture tells a different story:

Untitled

As unemployment rates climb from 2007 and peak during the Global Financial Crisis in 2009 the sickness certification for low back pain drops and plateaus. From the perspective of the General Practitioner patients are less likely to request sick certification when jobs are scarce. I was more inclined to accept the results of research by Michelle Foley and colleagues writing in the European Journal of General Practice in 2012 having interviewed GPs in Ireland:

GPs can find their role as certifier problematic, and a source of conflict during the consultation process with patients. GPs were concerned with breaching patient confidentiality and in particular disclosing illness to employers. They reported feeling inadequate in dealing with some cases requesting sickness leave, including certification for adverse social circumstances. Sickness certification was often given in response to patient demand. GPs felt a need for better communication between themselves, employers and relevant government departments

A few things struck me at the end of these visits to the library:

  1. Often the research that is most likely to impact on general practice is published in  so-called low impact journals. Often these are not randomised control trials or reviews of large databases.
  2. When interpreting ‘data’ we really need those who have regular contact with patients in the field to draw conclusions based on experience.
  3. The first question to ask a patient isn’t ‘tell me about your symptoms?’ but who are you and what do you do for a living?

For some people forklift driving is not a preferred way to earn a living but while there are options for alternative jobs ‘sick days’ may offer some respite.

Picture by bighornplateau1

Leave a Reply

Your email address will not be published. Required fields are marked *