Who really has all the pieces of the puzzle?


I’ve worked in pain management for quite a while now, and longer in work rehabilitation, and seen the process from almost all sides.  For ages I thought that, as the health provider working with the person in the workplace itself, I had most of the pieces of the return to work puzzle.  I mean, I did have access to the medical information, progress reports from other health providers, I spoke with and met with the employer, the compensation agent or funder, and worked with the person…but I’ve revised my ideas since my own rehabilitation.

I’ve realised that the only person who has all the pieces of the puzzle is the person who is returning to work. This person is the only one who has been at every health care meeting, treatment session, and progress report.  This person is also the only one who has met with the employer, been a the at-work rehabilitation meetings, and been in ongoing contact with the compensation agent or funder.

I think the importance of this fact may not be made clear to the person very often – it certainly wasn’t made clear to me during my rehabilitation. Although I should have known, I didn’t – even with all my experience!

Why is it so important?

Well, communication involves giving and receiving information – and often different members of the rehabilitation team are not entirely aware of all the pieces of the puzzle.  This can lead to talking at cross-purposes, sometimes inappropriate recommendations or progression in the programme, and even doubts of the person’s motivation.

What should the person who is going through rehabilitation know?

Here are some simple and completely unverified suggestions made up by me:

  1. The only person to have access to all the relevant information is YOU (the person returning to work)
  2. Keep a file with all the information from every consultation and treatment session you have attended
  3. Bring this file to every consultation (or a summarised version)
  4. Ask for a summary of every meeting, especially when it involves planning for changes in the return to work plan
  5. At any point, where changes to any part of the plan, or when treatments change, or whenever recommendations are made, it needs to be written down by the health provider concerned.  Then it can be produced at any meeting, especially where recommendations make a difference to return to work hours or duties.
  6. Sit down with the health care team member you trust the most, or by yourself, and work out what your ‘next best steps’ for returning to work are.  If you’re not sure what the next best thing is to do, take control and call a meeting (or ask your case manager, compensation funder or GP to arrange this) to work out what should happen next.

While the need to ‘take responsibility for your own rehabilitation’ is something that is emphasised in the New Zealand ACC system, what this means in practical terms is often not clear.  Some case managers use this phrase when they are finding it difficult to help the person progress, or if the person doesn’t want to comply with the programme that has been developed.

I think ‘taking responsibility’ is about being able to communicate effectively, and feeling confident that other members of the rehabilitation team will listen and consider what is being said. Trust between the rehabilitation team members is absolutely vital, especially for the most vulnerable member of the team – the person returning to work.

Think about it: the person has an injury/illness that has affected function.  He or she is now going through rehabilitation while also maintaining ‘normal’ home life and relationships, and at the same time is attempting to return to usual duties at work.  Life can be incredibly uncertain, and the person needs to be able to rely on the health care team to have his or her best interests at heart – and to trust that the team supports his or her goals, even when progress doesn’t seem straightforward or steady.

Who should communicate this very important role to the person?

Simple really, everyone!  Part of every health care provider’s role is to help the person to take control of the rehabilitation process – to help the person ‘take responsibility’ for their ‘next best step’ to recovery.

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