What do you do if your doctor doesn’t believe in RSI?

Question: What do you do if your doctor doesn’t believe in RSI? Doctors’ letters   In his book “RSI and the Work Related Upper Limb Disorders”, Dr. Paul MacLoughlin states: “Immediate rest … for as long as is required is the best treatment”. Rest can be achieved by time off work, or by avoiding provocative actions. Both need a doctor’s letter, so what do you do if your doctor does not believe in RSI and is not minded to issue a doctor’s letter?

Specifically, can a physiotherapist/osteopath/chiropractor or other recognized alternative practitioner issue a recommendation for adjustments in work equipment?  I work in an office and I need a telephone which does not have to be cradled under my neck, and I think voice-controlled software is a must for me. Has anyone had experience in an alternative practitioner recommending these, or indeed a main stream doctor who could be visited privately? I am thinking of the London area.

Answer 1: Try another doctor, when I had an idiot GP I always made a point of making appointments with other drs on my GP’s day off.  Or try suggesting that you have one of the many conditions that is included under the generic RSI label, such as carpal tunnel, tendonitis, tenosynovitis etc as he can’t deny that these conditions exist. I’m surprised he won’t give you a sick note, although you are theoretically allowed 5 days off sick without a sick note…  Rest is definitely essential in the beginning, your employer may act on the recommendations of a physio etc, but all depends on the employer.

Answer 2: I believe that an osteopath (and perhaps a chartered physio) can carry  some weight/recommend sick leave by way of letter if they think it’s  justified. Whether they would write with formal recommendations as to  equipment is another matter and up to them. At the end of the day I find  most of them say that something is needed but won’t say anything  specific – I’m having the same problems with getting anyone to pinpoint  what I need – they all say changes are required but no-one will say to  what! It’s very frustrating and getting me nowhere fast at the moment.

The proper people to make such recommendations are usually ergonomics or  occupational health professionals and my experience is that they won’t  work with you but want the employer to call them in – as outlined below,  in an ideal world this is something that the employer should do on your  behalf and if there is any willingness from your employer to help then  this is what I would recommend that you ask them to do. If there is  little willingness to help or accept the problem then you’re not alone  but the issuing of letters may not be what you need specifically and I  would strongly suggest taking legal advice.

Any evidence is, of course,  good in these circumstances, but letters to employers may just be  counter-productive and cause friction and problems.If you feel you need better equipment then you have a right to ask the  employer for it, either under health & safety legislation or disability  legislation. The latter also provides for changes in duties if they are  necessary, which might be an option. It always helps to have backing  from a doctor/physio/osteo but it isn’t legally necessary – conversely,  the need for your employer to assess risks and deal with problems  stemming from your employment and equipment is a legal duty.

You could approach Access to Work (Employment Service) either via your  employer or directly and ask them for help in assessing your needs and  recommending equipment – they should provide a free of charge ergonomic  assessment and then write to your employer and tell them what you need,  which is pretty official and should make them sit up and take some  notice. They also get stuff cheap, which employers often like!  I must say, I find it hard to believe (although not altogether  surprising from my and others’ experiences) that a doctor would not let  you have a sick note – although I suppose you are talking about a  seriously long time off rather than a week or so.

I would suggest you go and badger them again – demand a second opinion, referral to a physio or  consultant for a better diagnosis, etc. At the end of the day if you are  in pain and fear it is getting worse and might lead to a more serious  disablement then the doctor should take note of this and (surely?)  Recommend rest, work changes and/or treatment, as with any pain causing injury.Whether they call it RSI or something else doesn’t necessarily matter.

But you must try and get them to work with you in finding a cause and cure – if they don’t think that rest will have any effect or that work is causing the problem then I think they at least owe you an explanation as to why, and why they think the book (and much other  written material on the subject) is wrong in your case.They owe you a diagnosis and a course of treatment at the very least. Or change your GP…


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