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Fit notes for patients with chronic pain

Issue 35 Synovium (Spring 2012)

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A study published in the December 2011 British Journal of General Practice1 is the first of a (blockbusting?) trilogy examining attitudes to certification of sickness (or fitness to work) in patients with chronic pain. The first study examines GPs' attitudes. The second and third will examine employers' and patients' views.

As the authors state, the issues around illness, disability and certification can be complex and challenging, especially in illnesses where there are few if any objective findings and diagnosis is largely based on reporting of symptoms. In the first study – based on semi-structured interviews with 13 GPs – the authors found that key themes were (a) the rationale for the change from the sick note to the fit note which occurred in April 2010 and (b) identification of barriers to successful use of the fit note.

Most GPs thought that the notion of the fit note, with its positive message and shift of emphasis from incapacity to capacity, was valuable – especially in negotiating with patients who they perceived might be reluctant to return to work. The GPs did not think that the fit note had changed their beliefs with respect to maintaining the doctor–patient relationship. Some thought that the fit note placed more onus on the employer to make adaptations to accommodate the certified worker, and all felt that this was in fact a potential barrier to effective use of the fit note.

Overall the GPs felt that the fit note alone could not facilitate the change in culture needed to enable more patients with chronic pain to return to work, and that the need to preserve the doctor–patient relationship would continue to be a barrier to successfully challenging those patients who actively wished to avoid returning to work.

It will be really interesting to compare the different perspectives of GPs, employers and patients when the second and third studies are published. We hope this work will lead to more effective strategies enabling patients with chronic pain to return to the workplace.

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