Fear of OH – Get the Best from your Occupational Health Appointment

People who are asked to see an occupational health (OH) nurse or doctor at work, are usually apprehensive; especially when they have been ‘sent’, without any explanation as to why. They arrive with fear of OH and suspicion. I spot the feral look and know I have to put the worker at ease before I start to do my work.

Have No Fear of OH
Have No Fear of OH

I find workers who are in fear of OH fall into three bands:

  1. Who the hell are you? I have my doctor/specialist and they are 10 times better than you
  2. ‘Oh my god! I am in deep dodo – I need to get out of here. I’m saying nuffink
  3. This is going to be a cinch. I am going to get just what I want from this do-gooder.

But what works best, and we both need, is someone prepared to meet me halfway, with no prejudice against me, and is honest. It’s important to hear your story, what’s happened to you, your treatments, how you are managing at work? I’ll probably know what’s wrong with you – and, if it’s an unusual condition, looked it up on the NHS Choices website and NICE guidelines to see the recommended treatment.

My Role

So what exactly am I doing here?

An OH professional has four ways of helping you:

  1. I investigate a worker’s health to see if the workplace can help and, just as important, not help. For example, the workplace can’t help with getting you better (that is down to you and the treatment you’re getting). But we might be able to make work easier while you’re recovering.
  2. When you are ready to work again I advise your Manager of how to ease you back in gently. I know your Manager and options to keep you at work (S/he asked me to see you remember?) and the basics of your job (tasks, dangers, skills required)
  3. OH works within the framework of your company policies and procedures around health matters, for example, sick pay schemes, rehabilitation, opportunities for temporary or permanent job changes
  4. Occasionally, I find workers haven’t been to the doctor at all and need urgent treatment, the most common problem being diabetes or high blood pressure, which I can check there and then. I believe I have saved a few lives this way.

The Plan and Recommendations

I gather the information and come up with a plan, in discussion with you, that takes in all of the above, plus your own views.

For example, chemotherapy (cancer treatment): some people want to remain at work and keep everything ‘normal’. Others want to stay at home, resting in between treatments.  Usually, the choice is personal and can change as chemo starts as the impact of chemotherapy is dramatic and tiring.  I am hired by your company to say what is best for you, your job, and what will make work more tolerable.

Usually, Manager’s do not have the skills, knowledge and, just as important, the time, to devote themselves to your personal health plan.  Especially with the added pressures of health and safety.  No, you are better off with me advising…

I also help assess whether you can still do your job in the short term (broken legs heal, but when will you be fully fit?), or long-term (are you still able to climb ladders or escape from a building in a fire?) After I advise managers, they plan the work and other workers around that ‘plan.’

Manager Dispels the Fear of OH

Most problems and apprehension from workers is due to poor communication.  There following 8 steps are key:

  1. You are having, or say your having, health problems
  2. Your manager has concerns about your productivity, safety or fitness at work
  3. S/He talks to you about it
  4. You say its due to a health problem and the Manager wants advice how to handle it safely
  5. The Manager and you complete a referral  form setting out the health concerns
  6. The form is received in OH and you have an appointment to attend (workers who have a fear OH often refuse to attend, you are within your rights to do so)
  7. The worker attends OH to discuss their health problems in confidence
  8. The Manager receives the report to a) consider and b) put into action


Who Has the Final Say

Your Manager has the final word on the plan from OH. Because things may have changed since you had your discussions. You might have recovered or worsened.  The job might have changed.  Your treatment may be postponed or complications set in, such as an infection after an operation. You might develop a new health problem that interferes with the original plan.  Humans are not machines and the business world can change quickly.

The plan may need adapting.  And this is where the Manager has to make some decisions about the recommendations I made in my report, whether to:

  1. Accept
  2. Tweak
  3. Totally reject

To explain this tricky issue:

Your employer is responsible in law for any harm that might come to you and others while at work.  Not me, not you, or your GP.  The recommendations may contain some issues that I haven’t considered (only happens occasionally!) Something the worker didn’t understand at the time. In which case the report need tweaking or changing.  The Manager has to decide this.

Most Managers who cannot accommodate the recommendation will discuss why they can’t with you; occasionally they don’t (rare).  Don’t upset yourself.  The Manager has to defend his decision either way if there is an accident or tribunal.  I am merely an expert, hired to give competent advice, not direction.  In law, the buck stops with the employer and OH is just another employee of your company.

Protection from Work

My other role is in giving professional advice to Managers on how to protect workers’ health from their job.

For example:

  • Are you getting skin rashes from chemicals you use? (I do skin inspections, ask you to fill in health questionnaires)
  • Is your hearing affected by working with noisy machines or impact tools? (I do hearing tests, show you how to insert your hearing protection properly and why it’s important.)
  • Are we doing enough in training workers about health risks? (Do workers know that smoking increases the risk of vibration white finger?)
  • Are dust and fume affecting workers breathing and lungs? (I check lung function regularly with breathing tests)

The fear of OH, in this case, is about losing your job. What if I discover you have a poor health because of your work? Won’t you get the sack?

Tricky this.  But I have never heard of anyone getting dismissed because of work-related ill-health.  People can get moved to other jobs but mostly, an illness such as this is a red flag for the company to say they are not protecting their employees properly.  Again, the law is really clear here.  The company needs to tighten their methods of working because if one person has a health problem then there are probably others who are suffering too.

Companies can be sued and, if you were dismissed, you would probably have a good case for tribunal under various employment practice laws and the Equality Act. Also, the tests I do gives you evidence of harm.

So next time you are visiting OH, for whatever reason, remember we are medical experts advising on what is best for both you and your company.  We are on no-one’s side and have no real power, other than we are considered medical experts and are ethical and competent in what we do.

There is no need for your fear of OH.



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