How Can Doctors Help Their Patients to Return to Work?

F or most patients, work remains an important part of life. However, patients with chronic diseases often encounter diffi culties upon returning to work after an episode of illness [1]. Helping to reintegrate patients into their workplace should, therefore, be an important treatment goal for every doctor. However, in a recent review of back pain treatment, we found that patients were dissatisfi ed because they did not get practical instructions from their physicians on how to cope with everyday problems [2]. The same was found in a qualitative study of patients with breast cancer [3]. When we asked cancer survivors if they had discussed return to work with their attending physician, it turned out that only half of them had done so [4]. A reason for the perceived lack of support of patients might be that most doctors who treat patients feel unsure how they could be involved in " return-to-work issues " [5]. I would, therefore, like to provide a review of the most important theories involved in return to work and of the evidence for the effectiveness of interventions that improve a patient's functioning, including his or her return to work after an episode of illness. There is a wide range of disability among patients, even when they have had the same disease with equal severity. For example, among patients who have survived breast cancer after surgery and chemotherapy, sick leave is on average about a year, but it nevertheless varies from a couple of days to a couple of years. Among patients with testicular cancer who have undergone surgery, there is a variation of several weeks in the duration of sick leave [6]. For patients with nonspecifi c back pain, the variation is in a range of months [7]. It is not always easy to explain such variations, but the World Health Organization (WHO) provides a useful framework that helps in understanding the problem of return to work. The WHO explains in its International Classifi cation of Functioning, Disability, and Health how disease and disability are related (Figure 1). The model considers the infl uence of disease and its intermediaries on an individual's participation in society. Diseases or disorders affect the triad of " body structure and function " , " activities " , and " participation " , which lead to either disability or no disability depending on important conditional factors of environmental origin, such as …