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Tips on how to complete the work capacity certificate for psychological injuries

Dr Quentin Mungomery, psychiatrist and Medical Assessment Tribunal member provides general practitioners with tips on completing the Work capacity certificate - workers' compensation for patients with work related psychological injuries.

Providing a detailed medical assessment using the Work capacity certificate assists employers and insurers support the patient back to their place of employment as part of their recovery.

Tips on how to complete the Work capacity certificate for Psychological injuries

Welcome to today's webcast for Queensland GPs, proudly brought to you by the Office of Industrial Relations.

The focus of the webcast is to support and provide you with practical assistance on how to complete the Work capacity certificate when you have a patient presenting with a work-related psychological injury.

The Office of Industrial Relations is committed to delivering short and sharp education to better support Queensland doctors working within the workers' compensation scheme.

This topic is relevant for GPs because there are an average of 10,000 accepted claims for psychological injuries in Australia – three quarters of those claims are resulting in more than one week time lost.

Median time lost for serious claims for mental disorders was the highest of any injury type - more than double the median time lost for all serious claims.

Median compensation paid for serious claims for mental disorders was significantly above median cost of all claims $25,800 vs. $10,100.

The Office of Industrial Relations welcomes Dr Quentin Mungomery, Psychiatrist and member of the Medical Assessment Tribunal to share with you, some tips on how to complete work the Work capacity certificate for your patients who present with a work related psychological injury.

Thank you Dr Mungomery

Dr Mungomery - Hello, this is Quintin Mungomery and thank you for taking the time to listen to this webinar.

A new work capacity certificate was introduced in July 2016. It is available for use by doctors, dentists and nurse practitioners in a variety of formats and for convenience can be accessed online.

The certificate is used in the determination and management of the claim by insurers and also acts as a valuable communications tool between the various parties involved with an injured workers including insurers, employers, work rehabilitation providers and the various medical and allied health staff involved in their care.

A medical practitioner will usually complete a Work capacity certificate after seeing a patient they believe has suffered a work related injury. With information provided being of key importance in the assessment and management of the claim in assisting the injured worker back to work.

Psychological injuries are some of the most common injuries assessed by WorkCover Queensland.

The assessment and management of work-related psychological injuries at times can be somewhat complex and challenging with information provided in the Work capacity certificate is of key importance. This information facilitates the time and appropriate determination and management of psychological injuries and also assists in the engagement of injured workers in appropriate treatment and work rehabilitation activities.

There are five key sections of the Work capacity certificate including injury details, treatment plan, capacity for work, functional ability and rehabilitation and return to work planning. Today we will be focusing on the completion of the section of injury details and will be providing helpful tips on completing the other sections in future webinars.

To start, just a few general interview tips that may help with your assessment of injured workers, who given the work related nature of their injuries can present additional clinical and therapeutic challenges. It is suggested that a supportive and empathic interview style is often the best approach to establish and maintain therapeutic rapport and engagement. Considering the use of a combination of both open and closed ended questions is also often helpful in locating symptoms to make an accurate diagnosis.  Open ended questions do not require a simple yes or no answer and they can allow the injured worker to express their difficulties in their own words. As an example you can ask “can you tell me how your physical injury has affected your mood?”

Closed ended questions usually require only a yes or a no or one word answer and allowing more specific inquiry into key symptoms or other issues. As an example you could ask “have you been feeling depressed?”

It may also be a benefit to consider booking a longer appointment or having a patient come back for a second assessment if their presentation is more complex. Which is not uncommon in psychological injury claims. With the injured workers permission collateral information from family members or friends can also be of value.

The accurate documentation of a patients initial symptoms in clinical presentation, reported work and non-related work triggers and stressors can also assist in their assessment.

As the treating health practitioner however, it is always important to ensure that when assessing an injured worker that the patients care and maintenance of the therapeutic relationship remains the most important and primary focus of the consultation.

Now, just a few suggestions about clinical record keeping. The patient's initial report on work related stressors or any other non-work related issues may have contributed to their psychological difficulties at their first clinical presentation can often be very helpful in determining the cause of their psychological injury and makes accurate documentation in the clinical notes of importance.  It can be helpful to use the patient's own words when describing the nature of the stressors and associated psychological difficulties as well as more specific symptom terminology based upon your clinical assessment. As time allows, making more specific inquiry regarding details of the work related stressors injury or incidents as well as any additional non-work related stressors and contemporaneous documentation of such can also assist with the assessment and management of an injured worker.

When making a diagnosis of a work related psychiatric injury on a Work capacity certificate, the use of any medically recognised evidence based diagnostic systems such as the DSM or ICD is usually considered appropriate. If however the clinician feels there is insufficient information to make a formal diagnosis a professional diagnosis may be made. When providing such, using the term - psychological injury – and then describing the nature of symptoms the patient is suffering from for example psychological injury with symptoms of depression, anxiety and posttraumatic stress is a way of considering a provisional diagnosis.

It can also be a benefit to deferring a diagnosis for more serious psychiatric conditions such as posttraumatic stress disorder or major depressive disorder until there is sufficient clinical evidence to support such.

If the injured worker has previously suffered from psychological difficulties consideration as to whether the current work related injury is an aggravation of a pre-existing psychiatric condition is also important in this section.

Determination of work-related psychological injuries relies on the identification of a causal link between work-related factors/stressors/physical injury and the patient's psychological injury.

This required consideration of various issues including what has been the major contributing factor/s, any pre-existing psychiatric/psychological conditions, and any impairment in functional capacity due to pre-existing conditions.

The contemporaneous documentation of the patient's description of the cause of their psychological difficulties in as much details can be of great assistance in determining these various matters.

If however the link between patients stated mechanism of injury and the nature of the diagnosed psychological injury is unclear, you are able to document such on the certificate.

In this section it is important to document any pre-existing psychological conditions or factors/stressors that are considered to be causally related to the work related psychological injury.  Consider providing details of any psychiatric or psychological treatment (including medication) the injured worker was receiving at the time of their work-related injury or other information or documentation supporting pre-existing factors or psychiatric psychological conditions. Given the limited space on the certificate, it can be helpful to provide additional documentation such as specialist/psychologist reports or printouts of clinical records that may highlight any pre-existing psychological difficulties, conditions or issues.

So, in closing, the provision of relevant clinical information in the Work capacity certificate is of great assistance in the timely and accurate determination of injured workers claims and facilitates their engagement with treatment and rehabilitation activities. The Work capacity certificate can be a valuable tool to assist in the assessment, treatment and rehabilitation of injured workers towards the goal of returning them to work with health practitioner's completion of the certificate playing a pivotal role in achieving these goals.

Thank you again for taking the time to listen to this webinar and hope the information provided will be of assistance when completing Work capacity certificates for injured workers.

Thank you for listening to this GP webcast for Queensland GPs, presented to you by the Office of Industrial Relations.

Please look out for future presentations from Dr Quentin Mungomery and from the Office of Industrial Relations.

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