- Occupational health is independent. The clinician advises and your employer decides. What you tell the clinician does not reach your employer without your consent, except in the rare cases where the law requires disclosure, and medical detail stays with the clinician.
- The things not to say are the ones that stop the clinician helping you. Minimising, overstating, rehearsing a grievance and withholding relevant information all weaken the advice written in your name.
- Be specific about what you can and cannot do at work. Function, not diagnosis, is what the report is built on.
- You will be offered the report before it goes to your employer. Check the facts, ask for corrections and raise any disagreement then.
If you have typed "what not to say to occupational health" into a search engine, you are probably feeling anxious about an appointment you did not ask for. That is understandable. Most people have never had an occupational health assessment, and the advice that circulates online ranges from unhelpful to actively damaging. As an occupational health advisor who carries out these assessments every week, I can tell you there is no trick to it. But there are a handful of things people say, usually out of worry, that make it harder for me to help them. Here they are, with what to say instead.
First, what the assessment is for
An occupational health assessment is an independent look at how your health affects your work and how your work affects your health. The clinician does not take your manager's side. Professional standards require occupational health advice to be impartial, and the Faculty of Occupational Medicine's standards say that employers are entitled to advice about fitness for work, not to diagnoses or clinical detail without the employee's consent. Acas says the clinician must ask for the worker's permission before sharing an assessment with their employer, and the Information Commissioner's Office says workers are entitled to assume that what they tell a doctor, nurse or other health professional will be treated in confidence unless told otherwise.
So the starting point is that the conversation is confidential. What you say to the clinician is not what your employer reads, and it is not passed on without your consent except in the rare cases where the law requires it. What your employer reads is a report about fitness, adjustments and timescales, written in plain language, which you will be offered first. With that in mind, here is what to avoid.
The report is only as good as the conversation behind it. Understate things and the advice will not fit you. Overstate them and it will not hold up.
Don't say you're fine when you're not
This is the most common mistake, and the most costly. People minimise because they are worried about their job, or embarrassed, or because they have been coping for so long that struggling feels normal. The result is a report that says you are fit for your role with no adjustments, because that is what you told the clinician. The support you needed never appears in it, and if things go wrong later, the record shows that you said everything was fine.
Say instead what is actually happening. If you are managing at work by working through your lunch break and going to bed at eight, say so. The clinician's job is to translate that into advice that helps.
Don't overstate it either
The opposite mistake is just as unhelpful. Some people arrive believing they need to make the case for how ill they are, and describe everything as impossible. Occupational health clinicians assess function, and they see a great many people. They will ask what you did yesterday, how you travelled to the appointment and what you manage at home. If the account of your working capacity does not match the account of your daily life, or the fit notes and specialist letters on file, the report cannot lean on it, and the advice ends up hedged rather than specific.
Say instead what you can do and what you cannot, with as much precision as you can manage. "I can stand for about 20 minutes before my back forces me to sit" is far more useful than "I can't stand". Precise limitations produce precise adjustments.
Good practice
Think in tasks, not diagnoses. The clinician needs to know what happens when you lift, type, drive, concentrate, deal with customers or work a long shift. That is the language the report is written in, and it is the language your manager can act on.
Don't turn it into a grievance hearing
If the health problem is bound up with something that has gone wrong at work, a difficult manager, a workload that doubled, a complaint that was never dealt with, you will want to talk about it, and you should. Work factors that affect health are squarely within the clinician's remit, and the report can record that you identify work-related pressures and that resolving them is part of the way forward.
What the clinician cannot do is investigate the dispute, decide who is right, or write a report that reads as your side of a grievance. If the appointment is spent on the case against your manager, there is less time for the assessment itself, and the report is thinner as a result. Say instead, factually, what at work is affecting your health and how. Then use your employer's grievance procedure for the dispute, because that is the process designed to deal with it.
Don't hold back information you think is irrelevant
People sometimes leave out a diagnosis, a medication or a second condition because it feels private, or because they assume it has nothing to do with the question. Occasionally it does not. Often it does. A medication that causes drowsiness matters if you drive for work. A condition that flares under pressure matters if the question is about a phased return. The clinician can only take into account what they know.
Remember that telling the clinician is not the same as telling your employer. The clinician decides what is relevant to the questions asked and includes only that. General Medical Council guidance for doctors is that a report for employment purposes should contain only factual information that is relevant to the request, and not usually the whole record. We apply the same principle to nurse-led assessments. If there is something you want kept out of the report entirely, say so and ask what the clinician would advise.
Don't speak in absolutes, and don't ask the clinician to take a side
"I'll never be able to go back" and "I can do everything, just tell them I'm fine" are both statements the clinician cannot use. Occupational health advice lives in the realistic middle ground. What could you do now, what could you do in a month, and what would need to change. Absolutes close that conversation down.
Equally, do not ask the clinician to write what you want written, whether that is a particular adjustment, a particular return date or a view on whether you are protected by the Equality Act 2010. You can and should say what you think would help, and a good clinician will weigh it seriously. But the opinion in the report has to be theirs, or it is worth nothing to anyone, including you. Whether the Equality Act applies is ultimately a matter for an employment tribunal, and a properly written report will say so.
Don't skip the report stage
Before the appointment ends, the clinician should tell you what they intend to advise, and you should be offered the report before it goes to your employer. Under GMC guidance, a doctor should offer to show you any report written about you for employment purposes before it is sent. If you point out an error of fact they should correct it, and so should an opinion that rests on that error, though they need not change an opinion simply because you disagree with it. Read it properly. This is the moment to say that a date is wrong, that a task has been described inaccurately, or that you disagree with a conclusion.
You can also decline to have the report released. Before you do, think about what your employer will then base its decisions on. Acas notes that one benefit of agreeing to an assessment is avoiding your employer making big decisions without important information. A report that you have read and corrected is usually the most reliable account of your situation that anyone at work will see.
What to say and bring instead
- A plain description of your job, including the parts that are hardest right now
- What you can do, what you cannot, and for how long, in your own words
- What has already been tried at work, and whether it helped
- Your current medication and any recent fit notes or specialist letters, to hand rather than handed over
- Anything at work that you believe is affecting your health, stated factually
- What you think would help, even if you are not sure it is possible
- Any questions about confidentiality or the report that you want answered before you start
If you are sending this to an employee
Some employers share a piece like this before making a referral, and it helps. The most useful things a manager can do are to explain the purpose frankly, show the employee the referral form before it is sent, and keep the questions to a handful about function rather than diagnosis. Our management referrals page sets out the six steps to a better referral, and our guide to what happens at an occupational health assessment walks through the appointment itself.
Occupational health works when people talk to us frankly, and it protects them when they do. If you are due to see us and are unsure about anything here, ask before your appointment. We would rather answer the question than have you sit through the assessment worrying about it.
This article is general guidance for employers and is not individual medical or legal advice. If you are unsure how it applies to your organisation, contact our team.
