Return to work letter/form

[heyjack70]

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Many patient who are hospitalized and missing work need letters to take back to their jobs to justify the time off work. This is no problem, I just write a letter with the dates they were in the hospital and sign it. The problem is when the company wants me to state the person is able to return to work, usually stating "without restrictions", or state what types of work the person can do, or accommodations, etc. I believe this is beyond the scope of a treating psychiatrist and I have declined to do it on occasion. The thread about the German pilot makes this more topical. It seems like the employer is looking for my endorsement of the patient's health stability. Which, in the case of a broken leg is probably more cut and dry, but in mental health I don't want to state the person is stable to return to work only to have him flip out on someone and then have the employer passing the buck back to me, as the psychiatrist who said they were stable. I know a typical fitness for duty eval is a forensic assessment and costs hundreds of dollars at least, and is much more involved than a brief letter or form. How do you handle these forms? Do you fill them out, modify them?

 

[birchswing]

Wouldn't it be the same as a medical readmission to a college? My psychiatrist did that for me as did my PCP and psychologist. My psychiatrist's MO is to write as little as is possible. My psychologist tends to write more. My PCP writes very little, as well. I think the without restrictions is covering the company in terms of the ADA--not in terms of a patient going "crazy." Usually on these forms I've seen it written something like, "At this time, Mr. Smith returning to school part-time would be appropriate. He is stable and currently receives treatment once a month. To ensure his success, he needs X, Y, and Z (accommodations from the school)." I think the without restriction probably refers to not needing an X, Y, or Z. If a psychiatrist didn't do this, I'm not sure who would.

 

[wolfvgang22]

I keep it concise, answer only the question asked. I don't answer non-psychiatric questions, as I don't typically do non-psychiatric exams as an outpatient psychiatrist.

 

[F0nzie]

http://m.imgur.com/mPs76dQ

 

[F0nzie]

The worst is the forms from the lawyers. Questions like "how many hours can the individual maintain focus on a typical work day? 6-8, 4-6, 2-4, less than 1-2?".

 

[F0nzie]

I also love it when patients ask for letters knowing full well the letter is a lie then getting pissed that I don't write it. Lost a few headache patients that thought they were paying cash for get out of jail free cards.

 

[milesed]

We do these and always hedge quite a bit. "According to Mr. X, he currently reports no symptoms that may prevent his return..........".

 

[smalltownpsych]

I have had to do assessments of risk for patients to return to work. Mainly for suicidality. Some operate heavy machinery. I tend to report just the observable facts. Patient is denying current SI, mood appears stable as evidenced by____, patient has been compliant with treatment, has communicated understanding of condition and need for treatment. I usually conclude with final determination of fitness for employment is to be determined by employer, but at this point patient's functioning appears to be within normal limits.

 

[heyjack70]

I have had to do assessments of risk for patients to return to work. Mainly for suicidality. Some operate heavy machinery. I tend to report just the observable facts. Patient is denying current SI, mood appears stable as evidenced by____, patient has been compliant with treatment, has communicated understanding of condition and need for treatment. I usually conclude with final determination of fitness for employment is to be determined by employer, but at this point patient's functioning appears to be within normal limits.

I think this is a good strategy to state the employer ultimately determines the employee's fitness for duty. I question the 'had' part of the response though. Why did you have to put your neck out there and do this risk assessment regarding return to work?

 

[smalltownpsych]

I think this is a good strategy to state the employer ultimately determines the employee's fitness for duty. I question the 'had' part of the response though. Why did you have to put your neck out there and do this risk assessment regarding return to work?

I technically didn't have to do it, but I felt that it was in the patient's interest. I would rather ok my patient to work when they are communicating a desire to work as opposed to evaluate questionable disability cases.

 

[PikminOC]

I have had to do assessments of risk for patients to return to work. Mainly for suicidality. Some operate heavy machinery. I tend to report just the observable facts. Patient is denying current SI, mood appears stable as evidenced by____, patient has been compliant with treatment, has communicated understanding of condition and need for treatment. I usually conclude with final determination of fitness for employment is to be determined by employer, but at this point patient's functioning appears to be within normal limits.

Do you think the German wings pilot had this?
when it comes to lawsuits psychiatrists have much more risk and deep pockets to go after...

 

[TexasPhysician]

We do these and always hedge quite a bit. "According to Mr. X, he currently reports no symptoms that may prevent his return..........".

This is what I do when in my domain of mental illness. The key is "currently". I also put date and time. I state no duration of stability. I don't see it any different than a suicidal discharge from inpatient. There are no guarantees of stability ever.

 

[smalltownpsych]

Do you think the German wings pilot had this?
when it comes to lawsuits psychiatrists have much more risk and deep pockets to go after...

That is true about the deeper pockets, but isn't that why your malpractice insurance is more expensive? That's the price you pay for making mo' money than us! 😉
I read that the psychiatrist treating him recommended he not work so don't know if company was involved or not. Of course, I read that here so not sure how accurate it was. I tend to get pretty frustrated with the poor reporting and "expert" opinions on these types of incidents so don't follow too close.
If they do find the psychiatrist liable and he wasn't "clearing him for duty" then it could set up some sticky precedent. I have patients who operate heavy machinery, use weapons in the line of duty, and even provide medical care. It would be unlikely that I would ever tell the employer what was going on unless the patient told me they planned to kill people at work per Tarasoff. In fact, when someone is depressed and has a degree of suicidality, the employer would be the last place for me to break confidentiality. Usually spouse or parent is who I would talk to in order to come up with safety plan.

 

[PikminOC]

I am risk averse. It doesn't matter to me that I have insurance or what it costs.
Also, I don't want my name on any bottle of medication when a person is a CDL driver or pilot.