How to deal with Dr’s notes

I’m going to share with you advice on how to leverage the ergonomics process to ethically manage whenever doctor’s notes are received in the office. In this case I’m referring to when these notes either ‘prescribe’ a new piece of equipment or limit some physical tasks. We’re going to be looking at a way to match functional capabilities to that person’s workstation. Compared to more vigorous type jobs, doing this process in the office environment can seem quite simple but don’t let that limit your creativity for finding solutions. Before we start let’s just briefly go over my experience and what I bring to the table.

I’m a Certified Professional Ergonomist, have Master’s of Science degree, and over 10+ years doing ergonomic assessments in a variety of industries. I’ve worn many different hats in my ergonomics career – from consulting, to a position in the public sector (delivering participatory ergonomics programs), to finally running my own in-house ergonomics program. I’ve even managed short-term and long-term disability claims where I was able to learn this approach that I’m going to share with you today. I hope it adds value to your in-house ergonomics program.

The Value Of In-House Ergonomics Programs 

Let’s start with talking about the value of in-house ergonomics programs. If you have never heard of the term before, it’s where an employee has been trained to perform ergonomics assessments themselves instead of having to call-in expensive consultants for every assessment. I am a firm believer that about 90% of ergonomic assessments can be handled internally, provided that there is sufficient training and support available. When I managed my own in-house ergonomics program, I came across people only requiring basic ergonomic assessments so often that it actually spurred the idea of this website (but I digress). There will likely be about 10% of cases that may require extra help. As long as you can identify these types of complex cases requiring extra expertise and who to get help from (ie: someone with CPE certification) you are well on your way to providing value-added assessments in the office!

Now, we know injuries can occur inside and outside of work. In fact, it has been estimated that 80 percent of our population will experience lower back pain at some point in their lives. This is where the value of in-house ergonomics programs come into play: there is a trained ergonomics assessor on staff to identify and mitigate any ergonomic issues as they come up. If someone injures their back over the weekend they can get an immediate assessment of their workstation on Monday morning so any accommodations can be put into place. The same would apply if someone notices increased symptoms related to sitting in their chair. They can get low cost but high-impact (like making adjustments to their chair instead of purchasing a new one!) ergonomics solutions. In-house ergonomics programs are agile, they can respond to any internal need quickly and effectively. This clearly is a major time savings that outside consultants just cannot compete with – well, they likely could but it would come at a hefty price tag.

Relying On Outside Consultants. If you use an outside ergonomic consultant that can cost anywhere between $300-$1,000 for just the assessment of one workstation. The cost sharply increases if there’s a big workplace or if you’d like regular ergonomic assessments for staff.

Not Doing Anything. There’s a cost to ‘not do anything’ in your ergonomics program: injuries can STILL happen. Work injuries can cost a lot in direct and lost productivity costs. For instance, according to the Workers Compensation Board of Alberta, studies have shown that one carpal tunnel syndrome claim in an office can cost a company up to $12,000! And, that is only in direct costs too! This amount of money could technically be a organization’s ergonomics ‘budget’ for at least several years.

An effective in-house ergonomics program essentially pays for itself and is a valuable way to serve and improve the working environment for staff.

Begin Within A System

Usually managing an in-house ergonomics program means that you have some sort of connection with Human Resources (HR). I would say that for the most part, in-house programs are initiated from someone within HR and/or company executives. No matter what the catalyst is behind an ergonomics program, some sort connection with HR will be a big-win/value-add. Here are a few reasons why:

  1. You’ll likely get more support for your ergonomics program with a connection to HR. That could mean that you have more resources to get things done, more time allotted for vendor (like chair showrooms) visits/research, or even an increased budget for things like an ergonomics showroom that will help your program gain momentum with staff quickly.
  2. HR gives you a central location to store ergonomic reports for reference for years to come. This makes finding and referencing past ergonomic reports really straightforward and can be a major time-saver too!
  3. Connection with HR can give you insights to other factors that could influence ergonomics outcomes. This includes departmental budgets, staffing considerations, and if there are any ergonomic ‘hot spots’ aka staff who may have significant warning signs. This is a big win to assist with focussing limited time and attention on.
  4. There is MAJOR value in assisting with any return-to-work or other accommodations (more on this below!).

One last thing. With in-house ergonomics programs there is usually just one person managing both their normal job requirements on top of the ergonomic responsibilities. This means that time management is key and this past post can help you with that.

Dr’s Notes: Getting Functional Information

From my time managing short-term and long-term disability I learned that a key factor for a successful return-to-work and/or even a simple accommodation was getting functional information. This gave me something to work with. It meant that my workplace was able to get people back to work safer and faster. And, at the end of the day all parties were usually quite satisfied because of this too.

Doctor’s Notes. From time to time in any workplace you will very likely receive notes from staff informing you that their doctor has ‘prescribed‘ them a standing desk or new chair with better lumbar support, etc. In my experience, these prescriptions usually come at a hefty price tag for the workplace. Due to the size of the organization I managed, I would see quite a bit of these types of notes from doctors. I’ve found that basing any doctor recommendations or ‘prescriptions’ on that person’s functional capabilities (like how long they should sit and stand in a day) rather than outcomes (ie: for that person to use a standing desk) is much more of a value-add for all the parties involved.   

Here’s The Process We Used. After receiving a doctor’s note, the workplace would ask that person to try to get some ‘functional’ information from their doctor too. I stress here I only needed and asked for someone’s functional information; I personally never required any specific health or personal information. Some staff were reluctant sharing personal health information with the employer so it is best just to stick to functional capabilities. The goal of obtaining functional capabilities is of accommodation – aka ensuring that the ergonomics assessor can suggest suitable solutions based on the current functional capacity of the person. Depending on what the functional abilities and the duration of any required accommodation typical solutions may include any or all of the following:

  • An adaptive change/adjustment to optimize that person’s functional capability at their workstation,
  • Changing the working schedule/tasks,
  • Encouraging that the person uses pro-health behaviours/habits, and
  • Providing any necessary equipment (equipment may need to be purchased). 

The functional information that is valuable for this process is:

  • Estimated return to work date (if currently absent). This is useful for any return-to-work process so you can plan for that person’s return, making sure that the ergonomics assessor will meet that person on the first day of their return to adjust their workstation or put any of the suggestions in place from the above section.
  • If the person is fit, unfit, or fit with precautions. Many times if a doctor (or other treating practitioner) knew that the employer would accommodate the worker with precautions it would mean that the person could return to work in less time.
  • The estimated duration of limitations, or if they are permanent. As an example, let’s say that someone has an acute lower back injury and that they need certain work precautions (standing only work) for only a short amount of time. How you handle this situation would be much different if they need permanent work accommodations.
  • Date of next medical review. This may mean that any work precautions or set-ups will need to change according to any updated information.
  • Any functional limitations for:
    • Sit Continuously & Stand Continuously: is there a certain amount of time that is advised for prolonged sitting or standing? This is incredibly useful because it can form part of a sit-to-stand schedule.
    • Gripping: Holding the mouse etc.
  • Any restricted use of limbs. This information will help in forming an overall accommodation strategy. If someone has hurt their hand or arm, etc. this helps with the accommodation process. Let’s say that someone has hurt their dominant mousing arm. In order to accommodate this person, we’d have to look at different mousing solutions so that person’s productivity wouldn’t be negatively affected too much.

The value of an Ergonomic Set-up

How someone has set-up their workstation is a key factor to whether or not they feel discomfort, yet it often isn’t the main reason for a doctor’s note. After receiving a doctor’s note, one of the first things that I did when I managed my in-house ergonomics program was visit that person’s workstation to see if we could get any low-hanging fruit just by adjusting what they already had in their workstation. An ergonomics assessment with a thorough root cause analysis based on where that person’s discomfort was usually a solid start. After I did the workstation adjustments, I always made sure to follow-up with them to make sure that things were going well.

Often the people I assessed had never adjusted their chair or workstation and they were surprised on the effect that these adjustments had on their comfort.

Sometimes a case would require more than one follow-up with the staff member. Many times the amount of follow-ups were proportional to the amount of time that person was dealing with the discomfort- the longer the time they were in some discomfort it would typically take longer for their symptoms to resolve. If no progress was being made or if that person’s discomfort was considered to have moved to a chronic condition, I would suggest that person would need to a healthcare practitioner, whether it includes their doctor, physiotherapist, or chiropractor.

This situation reflects that the best ergonomic strategy is prevention. Many times doctor’s notes, etc could have been avoided if only workstations were set-up to fit them ergonomically in the first place. As they say, an ounce of prevention is worth a pound of cure! 

Following this prevention strategy, I think that most doctor’s notes that ‘prescribe’ certain equipment would likely be avoided in the first place.

Examining Alternatives

In my opinion, a prescription for a standing desk seems to be more of an ‘end’ of a conversation more than anything. Instead, I would encourage objectively looking at that person’s workstation and brainstorming alternatives (it may be the same outcome in the end) before jumping into any expensive solutions that may not actually solve the root cause of the situation.

If we were to take doctor’s notes just on face value, the workplace could assume that person would be standing all day with the suggestion of a ‘standing desk’ without the complimentary sitting and standing schedule. In actuality, long periods of prolonged standing is actually considered to be an ergonomic risk and should be avoided with a gradual and conservative standing schedule.

The value-add in this situation is to identify the root cause of this person’s discomfort – something that a thorough root cause analysis will identify. Let’s look at the alternative here. If a note recommends that the workplace purchase a standing desk, would that mean that the doctor recommends that person standing all day? That would not be considered to be ergonomic or even a preventative solution as standing for long periods of time is a long-term health risk.

Putting It Together

Step 1: The Dr’s note is received. In-house ergonomic support is called into to the situation and I would typically do an assessment immediately. This is even before the employer asks for functional information. The functional information would be used to refine any ergonomic adjustments made.

Step 2: The staff member is asked if they could provide some functional capability. Many times if the treating practitioner (aka doctor) knew that the workplace had an in-house ergonomics assessor and that the employer was willing to work with precautions/functional capabilities to accommodate that person meant that we’d have better success with this process. A good way to look at this relationship is that everyone is on the same team for the best outcomes with that employee.

Functional information is requested.

Step 3: Putting the plan in place by applying any functional information to that person’s workstation. Changes are made, new schedules/habits are suggested,  and new equipment may also be ordered. There is no need to rely on just a standing desk if the same outcome can be made by focusing on standing schedules and habits! But in saying that, sometimes a standing desk OR a new chair could be the only solution that would work that particular scenario. There is the value of a thorough ergonomics process that addresses the root cause of discomfort.

Step 4: Information about the accommodation plan/outcome can be shared with the doctor/treating practitioner as well to get feedback on more complex cases. This step isn’t necessary for every scenario.

In Closing…

I hope that this article gave you some insights on the value of in-house ergonomic programs in your workplace. If you have any questions or comments about this post please let me know below!

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Through the administration of countless assessments in both private and public sectors, Darcie has gained a wealth of knowledge and built a successful practice in the field of ergonomics. She has extensive expertise in conducting office ergonomics assessments in large scale workplaces for all different types of scenarios, from simple adjustments to incredibly complex cases. Darcie also has vast experience in delivering training presentations on the various aspects of ergonomics “best practices” in the workplace. Darcie is a Certified Professional Ergonomist through the Board of Certification in Professional Ergonomics, as recognized by the International Ergonomics Association. She also has a Masters of Science, specializing in ergonomics. A little known fact about Darcie is that she once scored from half, off a free kick, in a university varsity soccer (football) match!

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