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Patient Compliance Issues

The workplace may pose psychosocial issues that hinder patients’ return to workand symptom abatement. If there is low job satisfaction, conflict with supervisorsor coworkers, or the perception of high job demand and low probability of return to work by the patient, these issues are best addressed by open communicationbetween the employer and the employee/patient. Physicians do not have the time,or generally the knowledge of the workplace to contribute to this dialog other thanto explain the medical issues. The medical issues can be communicated in reports,or better yet by the combination of medical reports and the presence of a casemanager(many times a Registered Nurse, or Certified Case Manager) at the meetingof the employer and the employee/patient. The Cochrane review found someevidence(five randomized controlled trials) that this type workplace intervention iseffective compared to usual care to reduce sickness absence due to musculoskeletaldisorders (van Oostrom et al., 2009).

Unrecognized alcohol or drug abuse can be a medial issue that masquerades asa workplace issue hindering return to work, and physicians should screen for thispossibility with urine testing, interviews of the family, validated screening instrumentsfor assessing alcohol misuse, etc.

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