Medical Certification – GP v Physiotherapist

When it comes to RTW where do the best results come from?

My role requires me to attend many “fitness for work reviews” (FFWR) with injured workers who see both a GP and Physiotherapist regularly. Many of these injured workers only see their GP to obtain their certificate of capacity (COC).

I have left many FFWR conducted with GP’s feeling a little underwhelmed with the lack of constructive conversation and lack of movement on the worker’s capacity to undertake suitable employment. It has resulted in me asking myself the following questions;

1. Is the GP the best person to be talking to about RTW?

2. Is the GP the best person to be issuing the COC’s?

Sure, a GP might have the injured worker’s medical history and a long term relationship, but what clinical based exercises or daily physical function tests is the GP carrying out? From my experience none.

When it comes to being asked if the RTW arrangement is suitable for the injured worker, a conversation not to dissimilar to this follows;

GP – What do you think you have capacity for?
IW – I’ll be guided by you as to what I can or cannot do?
GP – Do you think you could lift 5kgs?
IW – Yeah I guess so? I’m happy to give it a try.
GP – Hmm, what does your physio have you doing at the moment?
IW – They work on my shoulder when I am there, along with checking how high I can lift my arm and has me doing some light weights. I also have home based exercises.
GP – Ok, I’m going to get in contact with the physio to discuss the arrangement and see what they have to say in regards to the matter.

If we were to flip this on its head and look at our recent outcomes when we have engaged the physiotherapist; asking them if they would be willing to take over certification of the injured workers’ capacity, the conversation goes something like this;

Physio – What do you think you have capacity for?
IW – I’ll be guided by you as to what I can or cannot do?
Physio – Well we have you lifting 5kgs in here, your mobility has increased in the last few weeks along with your range of motion. I think that most of these duties are within your limitations.
IW- My only concern is with ………… (specific task).

The conversation moves quickly to a more flavorsome conversation about tasks, hours, days and timeframes.

Why the difference I hear you asking. Well a physiotherapist is much more accountable when it comes to treatment and the payment of that treatment.

Physiotherapists are required to provide a treatment plan, with outcome measures and detail where a worker should be at specific points in time, based on the treatment they are providing. This plan allows questions to be asked of the Physio. and makes them more accountable regarding the injured workers progress.

So is the GP always the best person to be involved?

In my opinion, no, probably not.

Should we always engage the Physio in the RTW process?

Absolutely. They don’t always have to be the one issuing the certificates or even the one at the “fitness for work review” but if they are not present at the review, engaging them prior to meeting with the GP can only enhance our conversation when discussing return to work opportunities.

Note – a GP is not required to provide outcome measures or clinical rational to continue to certify an injured worker. A physiotherapist is asked to provide a treatment plan with clearly set out outcome measures. WorkSafe Agents can review and possibly cease Physio. if there is no progression.

2 thoughts on “Medical Certification – GP v Physiotherapist”

    1. Hey Karen – thanks for your question. Unfortunately there is not the flexibility in TAS and a GP must supply the certification. This is not to say that consultation should occur with a Physio., it should – you just can’t request that they issue the certificates.

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