Fifteen percent of staff who are ill for a long time are away for an extra 78 days with unexplained physical symptoms. This type of long-term absenteeism is not properly recognized, although it is very important for both staff and employers. This has been established by UMCG researcher Rob Hoedeman, who will be granted a PhD by the University of Groningen on 29 September 2010. In order to tackle this type of absenteeism the manager should not be too understanding, but not immediately threaten with a visit from the company doctor either. Hoedeman is not only a researcher but also an occupational health physician at ArboNed.
Staff absenteeism usually starts with recognized physical or psychological symptoms, but 15% of those who are ill for more than 3 weeks also suffer from ‘vague’ additional symptoms like exhaustion, chest complaints and dizziness. There’s often not only a single symptom, but several related ones. Such complaints are in addition to the actual illness, but often become the main reason for the absenteeism being extended by a third.
Hoedeman’s research has revealed that when people are ill at home they focus too much on their symptoms and limitations, meaning that they are no longer concentrating on getting better and returning to work. In addition, staff with serious, undefined physical symptoms have 3 to 6 times more chance of developing depression or anxiety disorders. They then end up in a vicious circle that can eventually lead to incapacity for work.
Hoedeman: ‘Of course the extra symptoms are caused by something, but employers often do not know what and they underestimate the consequences for absenteeism of the additional symptoms. If they gain the upper hand, the absentee (and the employer) is further from a solution than ever. They are only concerned with the unexplained problems, instead of concentrating on returning to work.’
According to Hoedeman, the vague symptoms of employees can be recognized. Employers could become more alert to recurring symptoms in employees that cannot be attributed to traceable physical causes. Hoedeman: ‘It might sound unorthodox, but employers have to trust their instincts. If Pete, currently at home with back problems, is not able to keep up at the building site and things aren’t going so well at home either, the employer should take swift measures to prevent non-traceable symptoms gaining the upper hand. The trick is to know your personnel.’
After three weeks an employee is often so deep in a downward trend that it is difficult for him to get back out. The only solution is to take measures more quickly than the usual 4-6 weeks. Pampering is the worst possible action. Hoedeman: ‘The manager often wants to be understanding and goes along with the symptoms. “Gosh, how irritating for you; stay home until you're properly well!" They understand the symptoms, but that is the wrong approach. It is better to understand the experience of the symptoms and to adjust the work accordingly. The opposite approach can also have an adverse effect: if you insist on a diagnosis, more intensive medical investigations or a referral, this will only increase employees’ unease and symptoms. Help the employee to see where the problems are coming from. If there is fear of a disease or fear of overdoing it, it’s a good idea to get him to contact the company doctor and draw up a treatment and reintegration plan.’
Rob Hoedeman (Utrecht, 1964) studied Medicine at the University of Utrecht and is an occupational health physician at ArboNed. He conducted his PhD research at the department of Health Sciences of the University Medical Center Groningen (UMCG). His supervisor was Prof. J.W. Groothoff. His thesis is entitled 'Severe medically unexplained physical symptoms in the sicklisted occupational health population’. Rob Hoedeman is chair of the STECR research group on physically unexplained symptoms and somatization and a member for NVAB of the national guidelines group for somatic insufficiently explained physical symptoms and somatoform disorders. He has written various national and international articles on physically unexplained symptoms and other subjects.
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