Navigating Occupational Health: Fitness for Duty Assessments

[00:00:00] host: Welcome to Fit For Duty, the podcast, elevating occupational health. I'm Dr. Larry Earl, president of the National Association of Occupational Health Professionals. As guardians of workplace health, we stand at the intersection of [00:00:20] wellbeing and success. Fit For Duty delves into hot topics, OSHA regulated exams, workers comp, drug testing, and so much more.

[00:00:29] host: Join us for practical tips, real stories, and conversations that spark change. Whether you're a seasoned professional or passionate about healthy workplaces, Fit For Duty is your [00:00:40] roadmap to a fitter, safer, and more productive workplace. Subscribe now on all major podcast platforms. Let's shape a future where well being fuels workplace excellence.

[00:00:51] host: This is Fit For Duty with Dr. Larry Earl.

[00:00:57] host: Welcome to another episode of Fit For Duty. For [00:01:00] duty, the official podcast of the National Association of Occupational Health Professionals. Today, we have a truly enlightening and eyeopening discussion lined up for you. We're fortunate to have Dr. Manijeh Berenji, an esteemed expert in occupational medicine, joining us to delve into our topic today of fitness for duty.

[00:01:19] host: In a world [00:01:20] where workplace safety and productivity are paramount, assessing an individual's ability to perform their job safely and effectively becomes crucial. Whether it's evaluating physical health, mental well being, or the impact of disabilities, Dr. Berenji has the expertise and experience to shed light on this [00:01:40] complex and vital aspect of occupational medicine.

[00:01:44] host: Throughout this episode, we'll explore the thought provoking questions that delve into the heart of fitness for duty assessments. From understanding the factors considered during the assessment process to navigating the legal and ethical considerations, Dr. Berenji will provide [00:02:00] valuable insights and practical advice that will benefit employers, employees, and anyone interested in ensuring a safe and productive work environment.

[00:02:10] host: Join us as we uncover the misconceptions, challenges, and success stories in assessing fitness for duty. Get ready to be captivated by Dr. Berenji's [00:02:20] wealth of knowledge and expertise as we embark on a journey towards understanding the intricate balance between personal health and professional performance.

[00:02:29] host: So sit back, relax, and prepare to have your perspectives challenged and expanded. This is an episode you won't want to miss. Let's dive into the world of Fitness for Duty with Dr. [00:02:40] Manijeh

[00:02:41] guest: Barenji.

[00:02:47] host: So welcome to Fit For Duty, Dr. Barenji. Nice to have you here.

[00:02:51] guest: Great. Thank you, Larry. It's a pleasure to be here.

[00:02:53] host: Yeah. So let's just jump right in then, uh, how do you determine an individual's fitness for duty? [00:03:00] And what factors do you consider during the assessment process?

[00:03:05] guest: Yes. So fitness for duty, for those who don't know, it is a type of exam that a lot of us in occupational medicine, perform when there is a question of someone's ability to do the essential functions of their job.

[00:03:19] guest: so an [00:03:20] assessment, entails a couple of things. We want to be able to assess the individual's overall state, both their physical state as well as their mental state. And really spending the time to, conduct that assessment in a manner that is conducive to not only obtaining the [00:03:40] information, but making the individual feel comfortable through the process.

[00:03:45] host: Right. And, and what do you find are the most common health conditions or disabilities that can affect an individual's ability to perform their job safely? How do you address these, as challenges?

[00:03:59] guest: [00:04:00] Yes, so, uh, in the 10 plus years since I've been practicing, I've seen a number of these types of cases.

[00:04:08] guest: Really the main one that I've seen as of late are mental health related. Um, we've had a number of individuals who have been brought in by, their respective management, to get [00:04:20] an assessment as to their mental state. many a time, these individuals have underlying mental health history, they are on a number of medications.

[00:04:30] guest: uh, I have taken care of, veteran employees who have had a history of, mental PTSD and other combat related, um, [00:04:40] medical issues. So it's usually a, a combination of factors, but, when it gets to the point where there is a disruption in the workplace, or if there is a, a potential threat to the individual employee or to other employees, that usually, gets us involved.[00:05:00]

[00:05:00] guest: Um, so in those types of circumstances, I do want to make sure that the individual is safe, that there's no signs of any suicidal and or homicidal ideation. do the necessary evaluation and get that individual to, the mental health professional. Depending on the severity of the situation, [00:05:20] they may need acute services.

[00:05:21] guest: So we are well equipped to be able to direct those individuals to the appropriate care services. Yeah,

[00:05:28] host: yeah, very good. I, I think you're right. We certainly have seen a resurgence, I don't know if it's a resurgence, but a surge of mental health issues. some may be, you know, related to, as you said, PTSD, [00:05:40] combat, some related to COVID, you know, we've had a lot of, stressors and outright mental health issues with that.

[00:05:48] host: Of the more physical,issues that you see with people going back to work, let's say they've been off for an orthopedic injury, right? And they have a physical job, and now they're returning to work. It [00:06:00] wasn't not a work related injury, right? And, but we're in the position now of assessing their fitness for duty almost like we would see, a pre, or a post offer.

[00:06:10] host: examination, right? How do, how do those physical limitations fit in when someone was doing a heavy duty job? Now they have, they've had an injury. maybe they didn't have [00:06:20] the same kind of, you know, physical therapy or rehab as if they were in a work comp injury. How do you deal

[00:06:25] guest: with that? Uh, yeah.

[00:06:27] guest: those are really difficult situations, because You know, there's been a number of, you know, medical issues that have come up and then there are physical limitations, which, can potentially impede their ability to do their [00:06:40] job. we usually get those individuals, to us in a variety of different fashions, but, the most typical is usually if there is a.

[00:06:51] guest: you know, a stumble or an injury that a co worker happens to witness and there's issues with that person getting up. A [00:07:00] lot of times there's just concern from the fellow co worker making sure that their fellow colleague is doing okay. Then when you actually do the evaluation, you come to realize that they have a whole host of underlying, um, conditions, both related to orthopedic conditions.

[00:07:17] guest: A lot of times there may be a [00:07:20] rheumatological condition involved. neurological conditions have come up, um, combination of these types of issues. So, these situations are hard and it's our job to be able to peace out, what's the most pressing issue that's impeding their ability to function, [00:07:40] making sure that the right.

[00:07:42] guest: professionals are involved getting the additional, um, information from their respective providers, just to create a holistic picture of this person's, overall capabilities. Um, a lot of times these cases, [00:08:00] you know, there have been issues ongoing for a number of years. But there's some sort of triggering event that kind of, uh, creates this domino effect where there's just one thing after another and usually that's kind of the point that we, come in to evaluate.

[00:08:17] host: You know, you mentioned triggering event, you mentioned two things that [00:08:20] I want to just touch on. and maybe we didn't talk about these before, but the two things come to mind. You said, um, trigger events and you said neurological issues. So one thing that. really comes to mind in return to work, to return to duty is stroke, right?

[00:08:37] host: some, some neurological event. And I think a [00:08:40] lot of our members are, CME examiners, right? They're medical, examiners for commercial drivers. And this is a huge area of concern for commercial drivers is stroke. So we're, you know, we're doing fitness for duty as part of the, regular FMCSA exam, but that basically is also a [00:09:00] fitness for duty exam.

[00:09:01] host: Do you have any, sort of special pearls about stroke in that population or similar populations?

[00:09:08] guest: Yeah, I actually had a case,when I was doing one of these, uh, DOT exams, I actually had an individual who, based on my evaluation, I, it turned out that he actually has had a number of [00:09:20] TIAs. Uh, over a short period of time, and I was able to kind of tease that out and determine that.

[00:09:29] guest: You know, this person is at a higher risk of developing a potential stroke, so, um, I had to do my due diligence in that case, making sure that this person, um, [00:09:40] was at least temporarily, um, not able to operate a commercial motor vehicle because I did have that suspicion, um, that he was potentially going to have a major event, um, and making sure that this person received emergent attention, and sure enough, uh, he actually, was was evaluated at the [00:10:00] right time because he may have had an event on the road and that could have been potentially catastrophic for a number of people.

[00:10:08] guest: So at the end of the day, we have to do our medical assessments and we have to look at the FMCSA guidelines and all the medical examiner, you [00:10:20] know, instructions and the manuals and, but we really do have to look at the person in front of us. And if there is a suspicion that there is a risk to this individual based on how they're presenting, we have to make sure that we are able to get that person the medical care that they need.

[00:10:39] guest: [00:10:40] Uh, to prevent a potential catastrophic event.

[00:10:43] host: Sure. Yeah. So I'm in a lot of situations with Fitness for Duty. You're looking at the personal safety of the individual, their co worker safety. Here you're looking at public safety as well. So, multi, multi factor safety issues there, right? Uh, yeah. So let's talk about privacy a [00:11:00] little.

[00:11:00] host: How do you balance the need for privacy and confidentiality? to ensure a safe working environment for employees because, you know, you're gathering data from other physicians, most likely, and you have to report something back to the employer about their ability to do the job, but, obviously [00:11:20] conscious of PHI, stuff they don't need to know about.

[00:11:23] host: How do you balance all that?

[00:11:26] guest: Yeah, it's a very fine balance. Um, at least in my experience, I've worked in a variety of different healthcare systems. over the past decade, um, really at the end of the day, it's about providing [00:11:40] information to the supervisor and the respective management on a need to know basis and really focusing on the ability of this person to do their job.

[00:11:51] guest: Are they truly Fit For Duty? And I really just keep it very short and very succinct. Um, I respect [00:12:00] the confidentiality of the individual, who has come to, my attention. And these circumstances are very delicate, um, so we always want to make sure that we're safeguarding the individual's privacy, making sure that we have all the releases signed off on, uh, from the get go, making sure that the employee is [00:12:20] a active part of this process, and ensuring that we receive consent.

[00:12:25] guest: Um, from the employee to contact provider or providers, should the case arise and really creating a tight knit, um, communication stream. Um, I [00:12:40] primarily use secure email and or phone call and really ensuring that all precautions are taken, to protect the employee's privacy as well as confidentiality.

[00:12:53] guest: And, uh, that is really, falling in lines with a lot of the standards that we're all familiar [00:13:00] with. clearly we want to make sure that there are no breaches. Of any, personal health information.

[00:13:07] host: I think really relaying that to the individual that you're evaluating that look, we're only sharing, your ability to perform the central functions of the job.

[00:13:15] host: We're certainly not going to share all the gory details of your illness with your. employer, [00:13:20] right? And so they, they just need to know that it is on a need to know basis. Um, so I like to make sure we had that communication. You know, you talked about, mental health issues a little bit, um, before, how do you actually evaluate mental health when you, if you're not a mental health professional yourself, how do you go about those valuations?

[00:13:39] host: [00:13:40] Um, clearly you oftentimes have to bring in specialty opinions. Um, are there other, yeah. Mental health assessments that are common to use on a more primary care, occupational medicine

[00:13:52] guest: basis. Yeah, I think this is a growing area of interest in occupational medicine because we're seeing such [00:14:00] a high number of these types of cases.

[00:14:02] host: Yeah, and you don't always have psychiatry readily available, right? There's a real access problem, so. That's

[00:14:08] guest: right. It's hard to get, yeah, absolutely. It's hard to get these folks in to see a psychiatrist and oftentimes, unless it's a, you know, a very acute [00:14:20] situation where there's a need for emergency psychiatric service.

[00:14:23] guest: you're absolutely right. It's going to be very difficult to get that person an appointment. So in my experience, I've had the ability to, really kind of take that deep dive into kind of understanding, basic manifestations of, you know, anxiety, depression,[00:14:40] taking advantage of some of the survey instruments that we have at our disposal, the generalized anxiety, disorder, survey, PHQ 9, which I know a lot of us are familiar with.

[00:14:50] guest: You know, being able to come up with some, systematic way to at least, quantify, and being able to create some, line of [00:15:00] medical evidence to at least support your conclusions, at least in that type of setting. Um, we always have those, uh, instruments available. We can conduct those pretty quickly.

[00:15:12] guest: Um, in the situation where you may have a bipolar patient or employee, I should say, things do get a little [00:15:20] bit more complicated, but I've been very fortunate to take advantage of some of the, um, CME trainings through the American Association for Family Physicians, or sorry, the American Academy of Family Physicians, I should say, and, they're really helpful tools to be able to use.

[00:15:37] guest: I know there has been a survey instrument that [00:15:40] I have used in the past. really trying to, identify, uh, at least in that setting, if this person is having, a manic episode, um, and being able to at least, again, having some sort of systematic way to, approach it if you're suspecting that this person may be having some sort of [00:16:00] manic, situation.

[00:16:01] guest: so I really, um, trying to, uh, hopefully instill in my colleagues to have the confidence to, you know, at least take the initiative, do the survey, um, try to gather some of those, um, some of that information during the encounter, because that can support your [00:16:20] decision making and provide additional context, especially in these types of encounters where, emotions are running high, the individual may not feel safe.

[00:16:31] guest: They may feel like they're under threat. So you want to make sure that you can have an approach that works. [00:16:40] Yeah,

[00:16:40] host: very good. Thanks for that. you know, when we, um, think about folks that we're seeing for when they're just hired for a job and maybe they have a disability that's already known about and, you know, we have to follow ADA and EEOC guidelines in terms [00:17:00] of, sometimes recommending accommodations for them, to be able to perform the essential elements of the job.

[00:17:08] host: Does that same concept hold true when you're doing a fitness for duty examination? How do you go about recommending accommodations for folks? Maybe who held the regular full time [00:17:20] job before, now they have a medical condition, they're going through a fitness for duty exam, they're not in the same condition they were when they first held that job, and now they need an accommodation.

[00:17:30] host: How do you manage that?

[00:17:31] guest: I was going to say, I've had a couple of these in the last few years and honestly every situation is so different, so it's hard for me to generalize, but[00:17:40] at least from my experience with these types of cases, There is a systematic approach to be able to kind of address the issues at hand.

[00:17:51] guest: Um, I have utilized the Job Accommodation Network. Um, it's a really great site for additional [00:18:00] guidance when you have these types of, situations where a person has multiple medical issues. there may be a physical component. being able to have additional, guidance, to navigate that type of, situation, really can be helpful, especially [00:18:20] if you're trying to work with the supervisor and try to kind of coordinate, a return to work plan, taking into account some of these additional, um, provisions like a reasonable accommodation, for instance, uh, every institution has a different process.

[00:18:37] guest: So. I always tell folks to make sure that [00:18:40] you know, your organization, understand where reasonable accommodation, sits in your organization, uh, develop, a relationship with these folks, and making sure that you understand how to get the information to the employee in the case that this person wants to proceed with a reasonable accommodation request.[00:19:00]

[00:19:00] guest: Um, a lot of times many folks don't really know how to access this type of information. Yeah, but it's really important to know what you have, at your disposal, take advantage of some of the, information from the job accommodation network and take advantage of some of the, guidelines that are out there.

[00:19:19] guest: I [00:19:20] know, ODG, MD guidelines through ACOM. Uh, there are a lot of guidelines that can help, navigate through these types of circumstances. Especially when there are multiple, moving parts and really trying to establish a systematic framework by which you [00:19:40] address, the medical issues as it pertains to their ability to perform their job and including, um, that documentation in your assessment, uh, and really just trying to create a cohesive process.

[00:19:56] guest: plan, that works for the employee and the supervisor.[00:20:00] at the end of the day, it's really all about communication and, you know, these types of situations can be really nerve wracking for the employee because they don't know if they're going to be able to really continue in their job. Um, I always say, let the process play out.

[00:20:16] guest: You're taking the steps that you need to take to [00:20:20] really at least understand what is capable or what is possible, I should say. And as long as folks have the information, they know who to turn to within the organization and having the occupational health provider, as a resource, to kind of help them [00:20:40] navigate through the process.

[00:20:41] guest: a lot of times that does really help, regardless of the outcome that might play out. You want to make sure that you are providing clear instructions to the employee and to the supervisor and management. So everyone knows what the expectations are [00:21:00] and how they can continue to, really achieve, the ultimate goal, which is to have some sort of resolution.

[00:21:06] host: Yeah. Excellent. yeah, absolutely. Thank you for that. Uh, you know, you mentioned, uh, some resources and, you know, one of them. Sort of my next question was, how do you, you know, how do you stay on top of all these things? So you [00:21:20] mentioned, uh, the Job Accommodation Network, that's a resource that we'll put in as a link in the show notes here.

[00:21:27] host: You mentioned, uh, the ODG, Right. The disability guidelines and MD guidelines, which is, it seems like it's almost ubiquitous, right? California, requires it for workers comp care. I don't know [00:21:40] if other states do, I think they do, but many, I think many states have adopted the MD guidelines as. you know, sort of the protocols that should be followed.

[00:21:49] host: What are some of the other ways that, our members can stay, sort of up to date on doing these types of assessments and given and have the confidence that they [00:22:00] have the resources available aside, aside from staying in tune with

[00:22:05] guest: NAOHP, of course. Right. I was just about to put a plug for you guys, but absolutely, um, making sure that you have access to high quality information.

[00:22:14] guest: you know, this is a great organization. Uh, the American college of occupational and environmental medicine [00:22:20] also, has, a lot of, uh, information. the conferences that are held, yearly, uh, there are many regional components of ACOM across the country. they are all inclusive, uh, physicians, MPs, PAs, case managers can attend, uh, highly recommend that folks take advantage of those.

[00:22:39] guest: [00:22:40] Opportunities both virtual and in person, to really kind of take that deep dive and, uh, developing that skill set, to be able to address these issues because, having the knowledge, really will not only help you, but it will help your colleagues at your institution, navigate through these types [00:23:00] of difficult situations and being able to access that type of information And having it readily available, can come in very handy.

[00:23:10] guest: So, definitely take advantage of,all of these, uh, respectable organizations and their CME offerings. Yeah. Excellent.

[00:23:18] host: Thanks. Thanks for that. you [00:23:20] know, some folks that are in an occupational medicine practice, maybe have not done a lot of fitness for duty exams. Um, what are some of the more common misconceptions about this particular part of our practice?

[00:23:38] host: Yeah, that's a

[00:23:38] guest: really good, that's [00:23:40] a really good question. Yeah, um, at least in my experience, I, I tend to have to educate my fellow peers about what a fitness for duty is. Um, you'll be surprised, or maybe not, but a lot of our medical colleagues don't really have an [00:24:00] understanding of What this type of exam entails.

[00:24:03] guest: Um, so I make it my kind of duty to kind of provide some context as to why these exams are being done. Um, it's really for not only keeping the employee safe. but also [00:24:20] making sure that the fellow, you know, co workers and other, employees across the organization, are in a, an environment that is safe and is conducive to a high quality performance.

[00:24:35] guest: Um, so at the end of the day, we want to make sure that everyone is. [00:24:40] Um, at their full potential and has the capability to do what they need to do during the course of the day. Um, but sometimes, you know, issues do come up and we want to create an environment where we have, uh, do recourse. in case there's a situation where, uh, [00:25:00] there is, an escalation of, you know, changes in, you know, like mental health.

[00:25:05] guest: I know that's been a big topic today. Um, you know, if we see a pattern and we see a progression that's happening, we want to make sure that our colleagues know that they can call us and work in tandem with. their [00:25:20] respective management, the human resources department and making sure that there is, a cohesive, strategy to deal with this type of situation.

[00:25:29] guest: Um, we would hate for someone to be put in harm's way, for the reason that, you know, an individual didn't know that our services existed. So I always use [00:25:40] this as an educational opportunity to raise awareness about what this exam is. And really not kind of labeling it as, Oh, well, you know, I was told to go to this exam.

[00:25:52] guest: I try to kind of re, kind of, kind of reimagine the fitness for duty is really,[00:26:00] you know, making sure that you're safe and creating, a safe environment for this individual. And we're just allies in this person's journey. So, I try to kind of re, reimagine is my word, I like that word, reimagine Fitness for Duty as a way to, kind of [00:26:20] address these issues in a way where everyone has the ability to contribute to the process.

[00:26:27] guest: And making sure that, it's not a punitive thing. I know sometimes some folks may think, Oh, this is kind of, uh, the last straw, you know, the employer is just trying to do this so they can potentially, [00:26:40] you know, terminate this person. That is not the case. This is really up most about safety, protecting employees across the board.

[00:26:50] guest: And if an employee is in distress or has. Like I said, a series of events that have led to a triggering event, which kind of [00:27:00] creates the situation, then we are a resource. And that is why we are in Occupational Health. We are really providing that service to our colleagues in those types of situations.

[00:27:15] host: Yeah, very good. You know, some of the misconceptions, I think, on the provider side of [00:27:20] folks who maybe haven't done this very much, and I know you're a medical legal evaluator, but many of them are not. And I think, they're concerned about about legal and ethical ramifications of performing these exams.

[00:27:33] host: How do you address that? What are those ramifications, and how do you address them?

[00:27:37] guest: that's a really good question. I feel [00:27:40] it's really kind of dependent on the situation at hand. so I always want to be cognizant of, the sequence of events that led to, uh, the fitness for duty and really, making sure that we can address, the most critical issues at that very moment, and then creating, a plan for, [00:28:00] further assessments But at the same time we want to make sure that this person knows that At the end of the day, it's about their health.

[00:28:08] guest: Uh, we want to make sure that they're able to, take care of themselves and their family. things do come up and a lot of times these folks didn't intend to [00:28:20] have a problem. the problem just kind of started to progress to the point where there was no turning back and it just really led to, the situation that they find themselves in during these fitness or duty exams.

[00:28:35] guest: So, at least in my experience, really trying to, [00:28:40] you know, help them in their time of need and really making sure that they know, that this is really for their health and their optimal wellbeing. I don't want them to really focus on the ramifications part because that could be overwhelming and that might not be the right setting during a fitness [00:29:00] or duty, to be honest.

[00:29:01] guest: looking at the ramifications is something that we would need to really evaluate kind of when the person is having the appropriate medical care and being able to really kind of address expectations. when the time comes up,

[00:29:18] host: our attorneys ever [00:29:20] involved in this, like on the, especially on the employer.

[00:29:25] host: well, it could be either, I suppose on the employer or the employee side, you ever had an attorney want to come and sit in on these evaluations?

[00:29:32] guest: Uh, luckily not, but, I'm sure other folks may have had such a situation come up. I don't think I have. I've heard of that. [00:29:40] Yeah. I don't know. I mean, um, I guess there's a first time for everything, but I have not had that happen. Um, in these types of circumstances, I do, always want to ensure that we're protecting employee confidentiality.

[00:29:56] guest: And having such a person in the room, could be [00:30:00] potentially seen as a breach of that. So, um, so yeah, I always want to make sure that folks know, that you want to, focus on the individual. if there is a request to bring in additional parties into the room, um, I always want to make sure that every single, action is taken [00:30:20] to prevent that, um, because that could potentially compromise.

[00:30:25] guest: the fitness for duty evaluation and the examiner's ability to, objectively address, the issues at hand.

[00:30:34] host: Yeah, I think that's the key is, is what, what, what do you need to do to remain objective, and [00:30:40] really speak the truth, right? We're, we're after the truth here. Uh, how do you communicate, particularly when, the individual is maybe not Fit For Duty or requires an accommodation that they never did before, how do you communicate these findings and recommendations to the employer in a way that is [00:31:00] objective and understandable?

[00:31:02] guest: Uh, yes. Uh, that. Uh, does require, uh, utilizing,terminology, from, you know, the Department of Labor. I know a lot of us are familiar, with some of these terms, but we always want to make sure that, we're incorporating, return to work language and work [00:31:20] restriction language and in the case that there's a need for a reasonable accommodation.

[00:31:25] guest: That we're using the appropriate terminology, based on understanding of the job description, understanding the job functions based on the department of labor, classifications, really understanding the fundamentals of the job, [00:31:40] uh, and really taking the time to learn more about this individual's work.

[00:31:46] guest: Um, in my experience, a lot of times, some of these individuals, you know, have a job description doing X. But it turns out that they're doing X, Y, and Z. Um, so you want to make sure that you obtain that [00:32:00] information from the supervisor or the HR, representative, making sure that you have a good fundamental understanding of their day to day and their work functions.

[00:32:12] guest: So that way, uh, the appropriate individuals can be involved, whether it's an ergonomist, whether it's a physical [00:32:20] therapist with expertise. in performing functional capacity evaluations. you want to be able to make this as evidence driven as possible. So you want to make sure that you really truly understand the person's job and you take into account all of these guiding documents and information, [00:32:40] um, to help you make your decision and incorporate all the respective stakeholders as well.

[00:32:46] host: Yeah, I think that's, maybe something that is not as obvious as we think it might be that you really have to have a functional job description. When you're setting out on these exams, right? You can't do this in a void. [00:33:00] You have to know specifically what does this individual have to do for, do they have to sit, stand, walk, push, pull, carry, climb?

[00:33:06] host: All those things that we think of, really need to be delineated in their functional job description before you can even approach an exam like that.

[00:33:15] guest: Exactly. I always tell folks, you know, if you find yourself in a circumstance [00:33:20] where you have a fitness suit for duty, It's very important that you try to get as much of this information as possible.

[00:33:27] guest: it really does help, in your evaluation process. And we try and we strive, uh, to make this as evidence driven as possible. so having that [00:33:40] functional description, having, um, as much information as possible to help you, kind of steer your, decision making. Uh, really will come in handy.

[00:33:52] host: Yeah. And, and I suppose if you, you know, if you're getting a referral from an employer for a fitness for duty exam and they don't have functional job descriptions, [00:34:00] they've never done them.

[00:34:01] host: Well, I suppose that's another opportunity for your practice to step in and say, well, Hey, you really need to have functional job descriptions. Let's, you know, let's help you out with that. Let's get our ergonomist or our therapist in there to do those for you. You had mentioned, this driver, I think you said it was, that had a TIA, and it sounded like maybe you saved his [00:34:20] life.

[00:34:20] host: So, so kudos for that. But are there other, can you share any other sort of success stories like that where your particular occupational medicine background was really key to improving workplace safety and productivity?

[00:34:35] guest: Yeah. I just had a case, uh, in the last year or so. [00:34:40] we had this individual, he was a veteran employee, was, uh, having, a conversation with his coworker.

[00:34:48] guest: And next thing you know, the conversation started to heat up, this individual started to get upset. There was a lot of shouting, and it got to the point where.[00:35:00] this person was, making a lot of verbal threats to this other coworker. So next thing you know, this person is escorted down to occupational health and I had to kind of gauge the situation.

[00:35:14] guest: So I was able to get him into the room. I kind of had him do some deep [00:35:20] breathing exercises just to kind of, you know, just to kind of get to a more stable state. And honestly, the deep breathing exercise really helped, cause I think he was just having a moment and, it turns out that he actually did have, a number of mental health disorders.

[00:35:39] guest: [00:35:40] Um, had been stable, but for some reason had not been taking his medications, um, and. You know, these types of things do happen, but in this circumstance, you know, just having him take those deep breaths and have him be present in the moment, kind of [00:36:00] reassuring him that, you know, he was having a, an episode and he kind of was able to regroup and he really was just.

[00:36:11] guest: You know, taken aback. I mean, he's never had anything like that happen. Um, at least at the, at the workplace. So, um, I was able to [00:36:20] deescalate the situation and luckily we do have an acute mental health center, um, for our veterans and He actually does have established care at the VA So I was able to walk him down to the acute mental health clinic and I was able to talk to the intake nurse and kind of explain, you know, what [00:36:40] was happening.

[00:36:41] guest: And, I mean, this is the beauty of the VA. you know, for our veteran employees who do have care, I mean, it was just a very, smooth, kind of process to be able to just walk them down, explain the situation, get the intake done. He was evaluated. he had a mental health [00:37:00] professional who was able to kind of assess the situation.

[00:37:03] guest: they were able to get him, back on his meds and on track and, I mean, I made a friend that day because he still sees me in the hallway and says, Hey doc. And I'm like, Hey, and, uh, yeah, it's just, you know, I saw he was in a moment of crisis [00:37:20] and our job is to really help deescalate. So if we have those kinds of situations.

[00:37:27] guest: really trying to just help the person, and breathing is such an important thing. You know, just taking that deep breath and just kind of letting all of that dissipate. Take a [00:37:40] moment. So I was really happy to

[00:37:42] host: do that. Yeah, that's a great, great story. Catastrophe averted. Great story. Thanks for that. Hey, we are at the end of our time, believe it or not.

[00:37:53] host: Time goes so quickly when we have such a fascinating discussion with Dr. Manijeh Berenji. Thank you so much for [00:38:00] joining us. This has been Fit For Duty. And that wraps up this episode of Fit For Duty. Thanks for joining me today, everyone. I hope you found this conversation as engaging and informative as I did.

[00:38:13] host: As always, building healthier, happier workplaces starts with knowledge and collaboration. So if you enjoyed [00:38:20] this episode, please consider subscribing to Fit For Duty wherever you listen to podcasts. That way you'll never miss a beat when it comes to the latest trends, best practices, and inspiring stories in occupational health.

[00:38:32] host: Until next time, stay safe, stay well, and keep elevating workplace excellence.[00:38:40]