The ABC of Fitness for Duty

Fitness for Duty (FFD) Assessment is an often misunderstood tool in the injury management toolkit. As part of our pre-poll at the live presentation on this topic, about two thirds of respondents felt they needed help understanding when and how to use FFD.

As a type of Independent Medical Examination, a FFD has the specific purpose of getting an individual back to work safely.

The FFD may arise in the context of work-related injuries, but also in the case of illness or injury which occurred outside of work. These ‘work-relevant’ scenarios are becoming more common, given the workforce is ageing and we are seeing increasing rates of chronic conditions.

Recent data released by the AIHW indicate most people with a musculoskeletal condition, such as arthritis or back pain, also have at least one other chronic disease.

Understanding why and when to use a FFD in the context of a worker’s employment journey is not always clear, and it can helpful to see an example to illustrate the process.

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Case study

Barry Smith is a worker in your organisation. His role involves manual labour. He’s 60 years of age and he’s had a gradual onset of back pain. Barry has had a couple of Workcover claims over the years and some physio. None of the previous claims have involved a specific event or incident. He wants to come back to work after 2 weeks off due to back pain.

You:

a) Tell him to turn up on Monday at 7 am sharp, shovel in hand.

b) Bury your head in the sand and grab another latte

c) Refer for a Fitness for Duty Assessment

Barry’s case demonstrates a history of prolonged non-specific symptoms with no antecedent event. This is an example of case where a timely FFD may be appropriate to get Barry back to his duties. A FFD Assessment is a specialist determination on capacity of an individual taking into account the objective physical and/or mental requirements of their job and the safety and performance needs of the employer.

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When should I refer for a Fitness for Duty?

A referral for FFD should be made when there is no clear diagnosis and an unclear management plan for a worker (for example, back pain is a symptom, not a diagnosis). A FFD allows for the diagnosis to be scrutinised – often with the benefit of hindsight and full suite of imaging and pathology results.

• When secondary diagnoses or non-work-related medical problems have affected recovery and the worker’s capacity.

• Where prolonged absenteeism or injury management issues are causing a delay in recovery greater than expected for the diagnosis.  

• When concerns exist regarding the nature, frequency and duration of ongoing treatment potentially causing risk to themselves and others.

• When a change in (or new) role has occurred requiring assessment of the the worker's ability to safely perform the inherent and essential requirements of the role.

• When you require a determination regarding foreseeable and significant risk of reinjury upon return to work.

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Writing a referral that gives you answers

Many organisations have standard templates to assist injury managers. Generic templates are a helpful guide but to be effective your referral needs to be tailored to the specific case. Helpful information to provide the assessing doctor includes:

• What job do you want the worker to do?

• If you have another job, what is that?

• Your precise concerns about the worker fitness for duty.

Commonly asked questions you can request the doctor to answer include:

• Can the person return to work – safely?

• What is the risk of recurrence?

• What is the risk to the person and others?

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Outcomes?

You’ve referred appropriately, asked the right questions, and waited your ten days for the report to be sent. Have you received the answers you were looking for?

The report should answer your questions. If it doesn’t, don’t be afraid to ask for clarification. When you book your appointment, be sure to ask about whether the assessing doctor is willing to receive a call from you about your particular concerns.

don’t be afraid to ask for clarification

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Choosing a Medical Specialist?

FFD should be conducted by a non-treating doctor, particularly one who is under no pressure to recommend a specific course of treatment. So how can you select the right medical specialist to perform the FFD assessment?

Let’s consider the following scenario - imagine you are driving your car down the street, and you notice a rattle which seems to be coming from the steering wheel. The first shop you pass is a tyre specialist. They advise your tyres are the problem. The second shop you pass is a power steering specialist. They advise your steering fluid needs a top up. The third shop you pass is a civil engineer. They tell you the problem is the bumpy roads. Each professional comes with their own bias. As long as you as the referrer are aware of the strengths of each speciality, this can assist your selection.

An Occupational and Environmental Physician has the benefit of specialist knowledge of the interaction of a person's health and their workplace combined with an evidence based approach to clinical decision making.

For more information, please contact us at LIME Medicolegal.

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