We all need a degree of pressure to get us up in the morning, but for each of us there is a point when the nature and quantity of the demands we face will outstrip our body’s capacity.
Hillary Clinton recently provided a stark reminder of this, collapsing at work with pneumonia. Jonathan Brownlee collapsed with dehydration at the end of his triathlon and we now hear that four of five doctors-in-training reports that their job causes them excessive stress and that three-quarters go through at least one shift a month without drinking enough.
As a patient, I do not wish to be harmed by “heroic” healthcare staff presenting to work with an infection they might pass on to me, or having to work dehydrated. As a member of the public I do not wish to be the passive recipient of impaired political judgements made by sick or over-fatigued decision-makers. More than ever “Great care” is needed at times of economic pressure to avoid situations where personal performance is so reduced that the costs of being at work outstrip the benefits good work bring for worker and organisation alike.
As occupational physicians, we care about your work and your health; and it is our role to point out the emperor’s new clothes to workers and employers alike when we see them!
This is not always comfortable, but it is what occupational physicians have done for generations - reducing previously tolerated workplace hazards such as asbestos, lead and noise. And the impact of work on health and health on work remains a major challenge, especially as our workforce ages. Ageing brings with it increasing susceptibilities to workplace hazards, as well as chronic conditions to contend with at work.
On the face of it judgements about work and health appear simple. We expect to arrive at work, fit for the tasks that we are expected to complete, not be harmed by them and often feel we (the workers) are best placed to make that determination. However, multiple factors from knowledge gaps, organisational pressures, worker-manager relationships (workplace culture) together with out of work issues make that the determination more complex. Rarely is this a topic we are able to discuss with a work-health professional. These are situations when occupational physicians add value. We assess the complex, multifactorial determinants of wellness; understand work demands/workplace risks and exposures; translate evidence-based, credible advice about what an employee can do into language they, and their manager, feel comfortable with; and most importantly have our advice trusted by both.
According to the HSE labour force survey there have been almost a quarter of a million cases of work related stress, depression or anxiety each year for the last decade (ref: http://www.hse.gov.uk/statistics/causdis/stress/index.htm ) . The suggestion that most mental health problems at work can be best addressed by “simple” mindfulness and yoga is a myth which only fuels the market for attractive, non-evidence based silver bullets to solve complex problems. Occupational Health practitioners must assess and persuade management to mitigate the many organisational factors that may pre-dispose to mental health issues, and support employees when the sources of distress are non-occupational.
Addressing the most complex needs of the few, through to the most prevalent needs of the many, calls for seamless, clinically-lead, multidisciplinary team working nurses, physiotherapists, case managers, psychologists, and more. Only when such teams are efficiently deployed are the best health and work outcomes delivered. This could be done efficiently with modest transformational investment and reconfiguration of services provided by the NHS to enable GPs and employers to access the services they need to best serve their patients and employees.
As with almost every other branch of health and care in the UK, occupational medicine is facing a sustainability crisis. Already thin on the ground, over half the UK’s occupational physicians are over 55 and a third over 60. Unless the pipeline is refreshed, and quickly, the costs will start to increase for each of us as individuals and employers in the next decade. This will be just as our ageing population will need us most. The NHS, increasingly challenged to attract and retain healthcare workers, and HM Treasury, looking to increase the productivity of the UK economy, will face critical challenges.
As a Faculty we can and do lobby hard for more resourcing, more training posts and better routes of access to care. As Occupational Physicians, the time could not be more urgent to demonstrate the value we bring, and the needs we can address for a healthier and more productive public and private sector workforce of any age.
Dr Richard Heron President Faculty of Occupational Medicine