Australasian Faculty of Occupational and Environmental Medicine
Recommendations from the Australasian Faculty of Occupational and Environmental Medicine on low back imaging, opioids, time off work and asbestos exposure. The Australasian Faculty of Occupational & Environmental Medicine (AFOEM) is a Faculty of the Royal Australasian College of Physicians (RACP) that connects and represents Occupational and Environmental Medicine Fellows and trainees in Australia and New Zealand.
Do not certify a patient as totally unfit for work unless the work absence is clinically necessary and the patient is unfit for suitable alternative or restricted duties.
While some medical conditions necessitate time off work, for example, a person recovering from surgery or experiencing debilitating pain, with many medical conditions there is a substantial discretionary element to work absence. So some patients may be able to participate in work if employers make appropriate accommodations.
There is substantial evidence to support a positive link between work and (physical, mental and social) health, as well as evidence that absence from work contributes to declining health, slower recovery times, and longer duration of disability. The certification of work absences due to medically discretionary injuries and illnesses should therefore be discouraged. When asked to provide an opinion on functional abilities to employers or insurers, medical practitioners’ focus should be on abilities; restrictions should be objective, specific, and listed only when medically indicated.
- Australasian Faculty of Occupational & Environmental Medicine / Royal Australasian College of Physicians. Australian and New Zealand Consensus Statement on the Health Benefits of Work 2011.
- van der Noordt M, IJzelenberg H, Droomers M, Proper IK. Health effects of employment: a systematic review of prospective studies. Occupational and Environmental Medicine 2014; 17:730-36.
- Waddell G, Burton A. Is work good for your health and well‐being? The Stationery Office (UK) 2004.
The College worked with the President and EVOLVE Lead Fellow of AFOEM to compile and refine a list of nine recommendations regarding low-value clinical practices in occupational and environmental medicine. This initial list served as the basis for an online survey. Based on survey responses, each of the nine recommendations was assigned a score and ranked accordingly. Based on the ranking of the initial nine, and the review of newly suggested items, these five low-value practices and interventions were chosen.
- 1 Do not request low back X-rays or other forms of low back imaging as part of a routine preplacement medical examination.
- 2 Do not order X-rays or other imaging for acute non-specific low back pain, unless there are red flags or other clinical reasons to suspect serious spinal pathology.
Do not prescribe opioids for the treatment of acute or chronic pain without assessing the patient’s clinical condition, potential side effects, alternative analgesic options, work status, and capacity to perform safety-critical activities such as driving a motor vehicle.
- 4 Do not certify a patient as totally unfit for work unless the work absence is clinically necessary and the patient is unfit for suitable alternative or restricted duties.
- 5 Do not repeat chest X-rays when screening asbestos-exposed workers unless clinically indicated.