• Jonathan Pittam

Should GP's be putting 'stress' on a sick note?


Metaphorical not medical


Stress isn’t a medical term, it’s a metaphor borrowed from the world of engineering, that was adopted by the father of stress research Hans Selye as a metaphor for pressure being placed on individuals.


If everyday stress doesn’t appear in any of the 947 pages of the DSM 5 (Diagnostic manual of mental disorders) or the 1250 pages of the ICD 10 (International classification of diseases), why are GP’s signing people off work with it? If it were ‘Depression’, ‘Anxiety’ that would be different, as they are recognised psychiatric labels, but ‘stress’ isn’t.


A quick ‘fix’


A 2017 systematic review of global GP consultation published in BMJ Open (British Medical Journal) found that UK GP consultations last just over 9 minutes, which indicates they don’t have much time at their disposal for exploration of what might be causing somebody to say they feel stressed.


In this article I’m going to share my thoughts on why GP’s putting ‘stress’ on sick notes, and managers suggesting time off might be having the reverse of the effect they imagine.


Sit and stew?


A young lady I was coaching recently had been previously signed off with stress by her GP, after she told him she’s being bullied by her boss at work. This bullying was clearly causing her distress, but in her case the time off just ended up giving her lots of time to ruminate and worry about the day she has to return.


Between us we worked on building her confidence in her ability to politely challenge her boss’s constant criticisms and ask for evidence, rather than him just making claims. The result was that she began to feel good about returning to work and taking control of her situation.


It seemed like the most obvious answer in the world


When I think back to my darkest times, the one thing I was absolutely sure would sort me out was moving out of the house I shared, and into somewhere alone. All I needed was to be alone and everything would get better. Or so I thought…


Many unconstructive months later I came to the realisation that being on my own was having the opposite effect I’d imagined. It was just me and my thoughts, and I believed every single one of them, as there was nobody to challenge me on them. Not a good thing when you have a head full of negativity. It’s easy to see why the longer somebody is off sick the less chance they will return to their job at all.


Based on a flawed assumption


The idea that everyday ‘stress’ leads to an activation of our sympathetic nervous system, and ‘fight or flight response’ has laid the foundation for the idea that when somebody is stressed, they should rest and relax.


After all, when the parasympathetic nervous system is activated the sympathetic switches off. It’s a beautiful hypothesis, and one that has led to us believing that time off to rest and relax solves stress. A hypothesis that is proving costly to people’s wellbeing, and also to the business community.


Rest from what exactly?


So, what exactly are we achieving by using time off as a solution? What effect will time off have on somebody reporting feeling stressed due to going through a divorce, marital problems, difficulties with their kids, lots of change at work, and so on?


We need 'problem-management' not 'stress-management'


Let’s consider the message this sends out about how to handle things in life that make us feel uncomfortable and distressing in many cases… “Just take a few days off and it’ll be okay, you’ll have de-stressed”.


If we remove the idea of an activated nervous system out of the equation, which by the way is also activated by excitement, exercise and even orgasm (maybe all of those are harmful too!) then what are we achieving through time off to relax and rest?


Facing life’s difficulties in a constructive manner seems like a far more effective way to manage the ‘stresses’ of life than stress balls or relaxation cd’s whilst wrapped in our duvets.


In the relegation zone


Did you know that the UK is bottom of the EU table when it comes to getting people back to work after sickness? What is it about this that we’re getting wrong? We know that once somebody has been off for 6 weeks the chance of them ever returning reduces drastically, so at the front end are we setting ourselves up for this by suggesting time off too readily, then not effectively managing the absence duration and the return as effectively as we could?


A change of strategy


But if rather than refer someone to their GP or suggest time off as the first port of call, could we maybe ask the person ‘what they mean’ when they say they're stressed? This simple change might uncover something manageable that we can work on in collaboration with the individual, something that maybe a trip to their GP for a sicknote won’t?


Food for thought


GPs don’t have the time to delve into life problems, so may use the s-word as a quick reason to write a sick note under the belief that time off to relax will relieve any stress the person is experiencing. But this is based on the flawed belief that everyday stress triggers our fight or flight response, and that relaxation is the antidote. Flawed beliefs lead to flawed actions, and this is a clear case of that.


So perhaps by GP’s and managers suggesting time off for stress, they may actually be having a detrimental effect on their person’s resilience and ability to manage life when it gets tough, not to mention the effect that unnecessary time off will have on teams and business bottom line, and co-workers.


It appears that in trying to do good, GP’s and managers may be doing more harm. Of course, sometimes time off may be necessary, but I’d imagine that for all of the times its used as a tool, it’s only the best option in a fraction of cases.


Where to next?


Encourage your managers to scratch beneath the surface before opting for the blunt tool of time off, or a trip to the GP, because they might find they have the resources to collaborate with their employee and resolve a mountain before it becomes a molehill.