Let’s stop oversimplifying the relationship between work and health
One of the things I love most about clinical medicine is hearing people’s stories. Taking a patient’s history isn't limited to identifying symptoms to narrow down a differential diagnosis, it's about understanding the full human experience. While someone might present with ‘abdominal pain’ or ‘difficulty sleeping,’ the real story often lies in the surrounding context: the stressors, the motivations, the relationships, and the responsibilities that shape daily life.
Roger Neighbour, the guru of the general practice consultation emphasised that the small details, the details often dismissed as incidental and even irrelevant in a time pressured GP appointment, may in fact be central to understanding a person’s presentation and their current needs. This approach holds true in occupational health settings.
When supporting people to remain in, return to, or adapt their working lives in the context of illness, it is a mistake to look at pathology in isolation. Of course medical diagnoses matter, but they’re only one piece of the puzzle when it comes to understanding workplace function, and function more generally.
In practice, I find it helpful to consider four broad domains that influence someone’s ability to function at work.
1. Pathology
The health condition itself and the symptoms it causes.
2. Management
How the condition is being treated: conservatively, medically or surgically, and whether treatments are effective, tolerable, or causing side effects, not forgetting potential for treatments to change.
3. Psychosocial Factors
The person’s wider life: everything from housing to relationships, finances and sources of stress or support.
4. Workplace Factors
The structure of their role, flexibility, relationships at work, and whether their job fits their current capabilities.
These categories each offer potential leverage points. Even when a diagnosis cannot be changed or reversed, other areas, like treatments, work adjustments, or psychosocial factors may have the leverage needed to improve overall function.
To do this well, people need access to support, ideally longitudinal support that allows for reflection, shared decision-making, and iterative problem-solving.
In an occupational health or GP fit note consultation (much broader-brushed abridged version)!, I gather data across these four domains. Then comes the analysis and collaborative decision making: what’s limiting function, and what could be changed to help things move forward?
Fictional case example: Mr T
Pathology
Mr. T is undergoing treatment for a cancer that was picked up incidentally. He currently experiences no symptoms from the cancer itself.
Management
He’s on a fortnightly chemotherapy regime that causes nausea and fatigue, especially in the 48 hours after treatment.
Psychosocial
He recently separated from his wife and now lives alone. His social network is limited, and due to treatment side effects, he gets groceries delivered. He rarely sees anyone outside his healthcare team. Work used to be his main source of human connection, which he misses.
Workplace
Mr. T is relatively new in his remote role but enjoys the work. He has good control over his diary and could theoretically work flexibly around his symptoms.
Points of Leverage
Management Plan:
How will the chemotherapy schedule change over time? Could less frequent or more tolerable regimes open up opportunity for more work? Could Mr. T even trial working a few days between current treatment cycles when the side effects are most manageable?Psychosocial Benefits:
Could a structured return to work offer Mr. T a sense of normality, routine, and valuable social contact, with a positive impact on his health?Workplace Flexibility:
Could temporary adjustments to hours, workload, or task types be explored to better match his energy levels?
These are the kinds of questions that could help lead to a shared plan. Any agreed plan for a case of this complexity should include regular reviews to iterate, including taking note of what’s working, what’s changed, and what needs to be adjusted.
Lara’s take
The relationship between health and work is complex, dynamic, and most of all, personal. It’s influenced not only by disease, but by treatment choices, social context, and the working environment itself. With the right approach, many people can find ways to stay connected to work: not despite their illness, but alongside it.
Understanding this holistic approach to work and health support, that must be, dynamic as well as personal will be essential to sustainably achieving economic stability in the UK.
There are no shortcuts. We need to more clearly communicate the nuances of the relationship between work and health to individuals, organisations, policy makers and the wider population. Building trust, in the consulting room and in the public dialogue is an essential prerequisite to having productive conversations about work and health. Parliamentary battles over welfare reform, talk of ‘points’ and ‘write offs’ do not set the scene for trust. Instead stakeholders including health professionals and employers should be prepared to talk about how health is not just about pathology, and how health, alongside other relevant factors can change with time in order to meet individuals where they are at on their journey.
