Although I exercise regularly and stay in fairly good shape (or so I thought), after several hours on the job, I was barely able to move and left whining hopelessly to my wife about how my stamina isn’t what it used to be. Years ago, my days off were generally spent building fences, cutting trees, and putting up hay. Now it hit me—I’m no longer fit for the job that I used to do for fun.

Fitness for duty (FFD) is a complex issue that confronts all businesses both large and small. It refers to the physical or mental readiness of an employee to perform the essential functions of the job. Over a period of time, that job may have morphed, or sadly, the employee may have morphed as well. Sometimes this can be a de-conditioning issue (like mine above) or there may be medical issues in play as well.

Our workforce is aging. According to the government’s Administration on Aging, the percentage of our population over age 55 now accounts for almost 40% of the workforce. Over half of that group self reports at least one disability: arthritis, hypertension, heart disease, and orthopedic problems are most often mentioned. Tasks that an employee performed without difficulty years ago may now be unmanageable or impossible. This situation needs to be addressed with compassion, truthfulness, and a willingness to find a good solution for both the worker and the boss.

There are multiple situations which could indicate that a FFD evaluation is needed such as: changes in health condition and medications that are reported to the employer such as a heart problem or recent surgery; changes in performance over time such as not meeting work demands or making errors; changes in mental status such as angry outbursts, withdrawal, or conflicts with co-workers; or suspected substance abuse.

What is the appropriate action for an employer to take in one of the above circumstances? First, make sure your actions are consistent, nondiscriminatory, and in agreement with your policies and procedures. If you are uncertain about this, consider a discussion with your legal counsel before proceeding. Second, consult with your occupational health provider who should advise you on the best course of evaluation.

A FFD evaluation by your occupational provider is usually performed in their clinic. They will take an appropriate history from both you and your employee to gain a complete understanding of the situation. A physical examination is usually part of this evaluation. Medical records may need to be obtained from other providers who have been involved in the care of this individual. Drug and alcohol screens may need to be collected.

In some situations, your occupational health provider may need to do a functional assessment of the job under consideration followed by a functional capacity evaluation of the individual to determine if there is a good fit. If not, functional shortcomings need to be determined. After all of the information has been evaluated, your provider should be able to make specific recommendations regarding the worker’s ability to perform their job.

If the worker is determined not to be able to perform the essential functions, you may need to consider appropriate accommodations. Again, your provider should be able to assist you and make recommendations.

Fitness for duty determinations often make both the employer and the employee uncomfortable. However, to ignore the situation places both parties in a position that can affect safety, productivity, liability, morale, and the integrity of the workplace.

This spring will mark my 20th year in occupational medicine. Back then, it was the beginning of a new era for this specialty. Providers were actually listening to employers and trying to meet their needs. It was a great time to practice because it was so easy to please people. A telephone call from a treating physician was unheard of at that time and returning an injured worker to modified duty with no lost time was a reason to celebrate.

Times have changed. Being around for 20 years allows a person to have a perspective that can only be acquired by experience. Trying to stay on the cutting edge of medicine is akin to throwing a dart at a passing bullet—your chances of hitting the mark are fairly limited. For my colleagues who are new to medicine, our “healthcare system” must seem like an incredible maze of practice patterns and regulations that make it impossible to keep pace. But for those of us who have been around awhile, it is easier to spot some trends.

Since I started my practice years ago, companies have really put some things together. For example, most of you have now figured out workers compensation and how to control your costs. You have learned to be in control—eliminate injuries through safety programs; reduce lost time with return to work programs; and, of course, work the “mod” to keep those insurance rates as low as possible. And if I had a nickel for every safety officer who has accompanied an injured worker to the clinic and has reminded me of what makes an injury OSHA recordable, I would already have that beachfront home in St. Croix that I like to fantasize about during times of stress.

Now is the time to apply the same principles with which you learned to control your workers compensation costs, to control your group health costs as well. Managing wellness and disease can reap huge dividends for those willing to invest. One excellent way to get started is to place a nurse practitioner in your company on a regular basis. This allows them to monitor chronic illness such as diabetes or hypertension and coordinate care changes before they become a costly crisis—both personal and financial.

Your team members will not have to miss work as frequently for urgent care, health maintenance issues such as allergy shots, or just to have that blood pressure checked. Every dollar that doesn’t hit your group health insurance helps lower your experience rating. Every hour at work not missed, hits your bottom line. It is the same principle you applied with your workers comp.

One trend I have noticed is that medicine is becoming less intimate all the time. I hope we don’t soon reach the day when you will report to the computer for your virtual physical exam (although having that colonoscopy online sounds like a good idea!). My sense is that people still like to have that personal touch, and no caregiver provides that better than a qualified nurse practitioner with immediate access to physician support. NPs are perfectly suited for this role.

Patients consistently choose NPs over doctors because they succeed where we docs often fail—they are good listeners. Sure, you can use a computer or a telephone to consult a faraway person who is also staring at their computer screen with care algorithms as they “individualize” your healthcare. But most of us still prefer that one on one, face to face encounter with our providers—someone who sees us on a regular basis and really knows who we are.

I have no doubt that in the next few years, most of you will be aggressively managing all of your company’s healthcare and productivity. I encourage you not to wait—there are advantages to take today. Here’s to the next 20!

Like many of you, I travel the interstate to get to work every day and it seems that the traffic isn’t getting any lighter. Every time I look ahead and see a long line of brake lights ahead of me, my immediate response is to look in my rear view mirror. If I see a large semi or dump truck bearing down on me at 70mph, I start to wonder; is this the guy I saw in the clinic last week with the drug problem? Is he awake and alert, or am I about to become the next highway statistic?

No joke. My associates and I see workers every day in our clinics that are hooked on drugs. Not the drugs you would expect however—I’m referring to prescription drugs. This is a growing epidemic and a serious public health concern. It is also a very serious concern for the small business owner as well.

For years now we have all been made aware of drugs in our society and the devastating effects they have on individuals and workplaces. The drugs we associated with this were the illegal ones—marijuana, cocaine, and methamphetamine to name a few. However, according to SAMHSA, the Substance Abuse and Mental Health Services Administration, drug abuse has a changing face. Their 2007 Survey on Drug Use and Health revealed significant declines in the use of illegal substances. The abuse of prescription drugs, especially opioid pain relievers like hydrocodone, oxycodone, and methadone is skyrocketing.

Prescription drugs are now the second most abused class of drugs, second only to marijuana. However, if you look at those who are currently initiating abuse, prescription drugs are now number one. And it isn’t just our youth who are abusing. Prescription drug abuse among 55-59 year olds doubled in 2007. It appears some old hippies have found a new groove.

Why is this happening, and what does it mean for the business owner? There are many reasons for this change in culture. Unfortunately, there has been a trend in recent years to overprescribe pain medications for benign chronic syndromes like low back pain, bursitis, and fibromyalgia. Ibuprofen just doesn’t cut it anymore. Doctors with shrinking margins in a volume-based practice sometimes don’t have the time to address real issues with patients. It is easier to write a script. And of course, physicians have been slammed for the undertreatment of pain. It is a tough balance and one that is hotly debated in medical circles.

Another growing concern is the availability of drugs on the Internet. The Drug Enforcement Administration has made it clear that the standard for prescribing controlled substances is that it must be for a legitimate medical purpose by a physician acting in the usual course of professional practice. Internet doctors who have patients fill out a questionnaire and then dispense prescriptions do not in my opinion meet that standard.

We often see workers who are taking an incredible amount of prescription pain killers, anti-anxiety drugs, sedatives, and hypnotics that can directly affect their ability to perform. There is a sense that because these drugs were prescribed by a physician that they are not an issue in the workplace. However, having a legitimate prescription for a drug doesn’t obviate the safety or performance problem. These workers are driving forklifts, operating equipment, and performing other safety sensitive duties while their cognitive functions and ability to react may be greatly impaired.

Sometimes an argument can legitimately be made that individuals who take these medications tolerate them well and it doesn’t affect their ability to function. While there can be some medical truth to that, from a risk management standpoint I think that is a weak argument. If someone in your business is involved in a serious accident which results in injury or fatality and it is discovered that they were taking these drugs, don’t you think that it will become a major issue? The question will be asked by OSHA or a court-why was this person working and allowed to take these drugs?

Awareness of this growing problem is your first step. Discuss it openly with supervisors and your entire team. Put policies in place that spell out what a team member is supposed to do if their doctor places them on medication. At minimum, they should discuss with their physician whether or not they believe a new medication could affect their ability to work. Who do they report to and what is done with the information? If they have a serious medical problem that really requires these medications, then accommodation may have to be addressed.

Consider your drug testing program. Does it effectively identify the prescription drugs that are commonly abused? All drug tests are not equal. Special panels are sometimes required to identify an offender. When you are in doubt about whether someone has a medical problem that requires prescription drugs or someone who may be abusing legal substances have your occupational health provider evaluate them for fitness for duty. Do not let confidentiality concerns stand in the way of making your workplace safe. There are legal ways to do this.

The drug problem in our society is not going to disappear for a long time. Great strides have been made and we can all hope for the day when illegal substance abuse becomes a rare phenomenon. Unfortunately, prescription drug abuse seems to be taking its place. So for now, I’ll be the guy you see in the next lane over who is looking in his rear view mirror and squirming in the seat.

Everyone knows that improving eating behaviors, modifying sleep habits, and exercising more consistently can extend life expectancy. Moreover, simple lifestyle changes can decrease health costs. So knowing this, why are companies still resistant to promoting wellness programs?

At The Human ReSource, LLC, we have found that many companies view wellness programs as difficult to administer and present too much challenge with regard to monitoring use and success. Yes, some Louisville and Southern Indiana companies are offering wellness programs. However, according to a SHRM (Society of Human Resource Management) survey, only 58 percent of companies (employing in excess of 250 employees) nationwide offer wellness programs, and the percentage of smaller companies supporting wellness programs is significantly lower.

But consider this; on average, Americans are spending an additional 10 hours working each week. This offers employers a unique opportunity to positively affect healthier habits. Of course, not all employers can afford to invest in a 30,000 square foot employee fitness center; yet there are simple ways and inexpensive methods to influence healthier choices to improve employee wellness and employee retention. The goals for any wellness program, large or small, is ultimately to educate employees to live healthier; thereby, healthcare costs are reduced, a supportive work environment is established, and employers experience less absenteeism and higher retention rates.

So, no matter your company size or budget, you too, can develop a wellness program for your employees. First things first, decide who will champion this effort. It will be important that communication is centralized and consistent throughout. Someone who has functioned in human resources or someone who is well-respected by your employees would be best. The second step is to determine general guidelines with regard to how information will be communicated (i.e. company website, newsletter, etc.) and the amount of time allotted to the program. Generally, even after a simple program is developed, it should be expected that this effort will require approximately 10 hours each month from your chosen “Wellness Champion.” Lastly, work with other companies in your area that are promoting wellness programs and seek out local agencies or businesses that cater to employers offering wellness-at-work programs (i.e., YMCA, local hospitals, etc.)

The suggestions below can be used to jump-start your own wellness plan on a budget.

ü Illustrate management commitment to the program during a healthy employee luncheon – introduce the plan, program administrator, and newly created “wellness” newsletter.

ü Get employees involved in writing wellness and fitness articles and submitting their own favorite heart- friendly meals.

ü Ask employees to actively share information about community or neighborhood sponsored activities, walking, biking, health screening, etc.

ü Team with a local fitness instructor to reduce fitness class enrollment fees for your employees.

ü Work with a local healthcare facility or hospital to provide wellness literature to employees.

ü Make smart vending machine and luncheon choices – reduce fatty foods and add wholesome health bars, fresh fruit, and healthier drink choices.

ü Provide employees with pedometers and have a contest for the most steps in one month – celebrate all successes!

ü Offer information on how families can work together to improve overall health by exercising together.

Keep your efforts modest, if you choose, but keep your commitment to your employees constant. With minimal time and investment, you can promote a healthier workplace that results in improved morale and enhanced employee loyalty.

Like all of you I have groaned at the gas pump as the price for regular unleaded fuel reached four bucks a gallon. Unfortunately my old sedan is supposed to be fed a high octane fuel which pushes the price even higher. I have been obedient to this demand for years without much thought, until recently. My car is not a high performance vehicle so why should it require premium fuel? I decided it was probably a conspiracy between the engine manufacturer and the gasoline companies. I tested my theory with a tank of regular low octane. My reward was a car that ran lousy for the next 300 miles—pinging, missing, and actually getting worse mileage, thus costing more in the long run.

As small business owners we face some difficult economic realities and all try to avoid unnecessary expenditures. When it comes to the health and well being of our employees, trying to skimp is sometimes like the above scenario with my car. Our employees are the fuel that drives the engine of our business. It makes sense to ensure that they are in optimal condition to do their job, but is that cost effective?

Employees who suffer from poor health and deconditioning are costing us higher injury rates, higher insurance and benefit rates, absenteeism, and “presenteeism”. Presenteeism refers to the employee who is “on” the job but not really “in” the job—not producing at full capacity. Perhaps it is because their blood sugar is out of control or they have migraine headaches. Depression alone accounts for huge losses in lack of productivity. What to do?

First, understand the huge impact employee health has on your bottom line. The intangibles—lost productivity and lost time far outweigh any direct medical expenses. Many good studies have laid to rest any argument about return on investment in your human capital.

Second, boldly begin the process of change within your organization. Corporate wellness programs are springing back to life with a vigor not seen since the jogging craze of the late 70s. Simple measures can be instituted that will encourage employees to become healthier and more productive by having the fat and sugar laden snack food machines removed from the break room; regularly arranging for someone to bring in fresh fruit; banning smoking from your workplace and offering incentives to those who will quit altogether; hosting special speakers for meetings or lunches to discuss diet and exercise. Health fairs can be another great way to motivate others to action.

As your program evolves, take it to another level. Most small companies cannot afford to have a full time medical staff. Bring in a nurse practitioner or a doctor for a few hours every month to help your team members stay focused on managing their health. In addition, providers at this level can often treat urgent care type problems that will eliminate the need for your employee to take off work that half day to see a doctor. Problems can be identified before they become costly and out of control. Serious or chronic problems can be coordinated with their primary care physicians for ongoing management.

Consider this scenario. Your employee Thelma, age 41, works day shift and has been with your company for five years. Thelma is a single mom with three school-age children. Life isn’t easy for Thelma. Being on a limited budget, most of her meals come out of the microwave, sloshed down with a gallon-size soda pop. She is diabetic but doesn’t really attempt to eat properly. Her blood sugar runs about 280 (not good) on most days. Not coincidentally, her weight in pounds matches her blood sugar level. She smokes about a pack of cigarettes per day. Home life is a boring routine played out monotonously 24/7.

Thelma works on your production line and shows up for work—depressed, fatigued, dizzy and overdosed on nicotine and caffeine. Kentuckiana is full of Thelma’s. As physicians, we have seen her in our clinics, offices, and emergency rooms. How productive do you think Thelma can be today?

Contrast Thelma with Louise. Louise is also in her early forties and has been employed by the same company for the past 5 years. Louise has lost 62 pounds over the last 2 years, thanks to a company-sponsored program of diet and nutrition. Her diabetes once required her to take two medications daily, but they didn’t really control her blood sugar. Now her blood sugar level is well-controlled on one medication and her doctor thinks that may not be necessary much longer. Louise gradually quit smoking over the past six months. When cigarettes were banned from the company property where she worked, she was motivated to sign up for the smoking cessation classes that were being offered. With the money she has saved on cigarettes and medication, Louise has started taking karate lessons 3 nights per week. Louise teases that she has more energy now than she did as a kid. Louise works on the production line across from Thelma. How productive do you think Louise can be today?

My point is this: You have been blessed with a great opportunity to change Thelma into Louise. You don’t even have to be philanthropic by nature to make it happen, just frugal. Every dollar you spend to help the transformation will be returned to you at least threefold. A team of Louises will significantly add to your bottom line and you will have the satisfaction of knowing you improved the quality of life for someone entrusted to your care.

I encourage you to start today. Go high octane and see if your operation doesn’t run more smoothly and give you better mileage.

How many times have you heard that we are experiencing a paradigm shift in the way we approach something? Thomas Kuhn, in his 1962 book, “The Structure of Scientific Revolutions,” coined the term paradigm shift to describe a change in basic assumptions within the ruling theory of science. Since then, the term has gained more informal popularity and is used to describe everything from the evolution of Western society to the consistency of peanut butter or the movement of the three point line in college basketball. I recently heard that employee health and wellness was also undergoing a paradigm shift. I’m pretty sure that healthcare in general has been undergoing a paradigm shift of some sort ever since I started practicing medicine in 1981. Back then it really bothered me that something I had just spent 11 years trying to learn was about to suddenly change. Today I understand that change isn’t always what it appears to be.

In the late 1970s and early ‘80s, health and wellness was the rage among the 30-something crowd. I belonged to a local health club and a slot couldn’t be found to slide into on the indoor track after work on weekdays. We jogged and socialized and generally felt like we were going to live to be 100, without the first Advil. CEOs were in on this as well, and those that also jogged were convinced that all of their employees should jog and stay healthy just like them. Thus was born the “wellness” program.

The idea sounded great. Just get everybody to eat right, sleep right, exercise, and meditate and the whole company would be one superhuman bundle of energy, ready to be harnessed for the corporate good. Then somewhere between the sweat on the jogging track and the donuts in the boardroom, the wellness program usually got dusted, because nobody could convince anybody that there was a real return on investment. Let’s face it—money talks.

Wellness didn’t go completely away, however. It still sounded like a good thing to do, and intuitively, everybody wants to be healthy. Many companies have had good intentions and promoted health and wellness. There have been the brown bag lunches where the health topic “du jour” has been discussed. Many companies have annual health fairs where you can get your blood pressure checked and are told that your cholesterol is slowly clogging your arteries. Wellness boards advise on a monthly topic, such as self breast exams or prostatic enlargement (no self-exam here, please). But usually in the end, the efforts are somewhat fruitless and poorly productive because nobody wants to spend the money to have a real program.

According to the Integrated Business Institute, or IBI, the problem is not the worth of an employee health and wellness program, but how we view it in the scheme of an overall benefits plan. The IBI is a nonprofit organization that is comprised of many stakeholders: large employers, insurance companies, healthcare providers, pharmaceutical companies, and third party administrators. The IBI analyzes health and productivity issues as they affect traditional benefits programs such as worker’s compensation, group health, and non-occupational lost time from work. Their research has shown that the traditional view of benefits programs shared by most CFOs, CEOs, and business owners is that health related benefits are a cost to be managed, reduced, or shifted to their employees. There is disconnect between benefits programs and how they drive productivity and thus, the bottom line.

Few companies really make an effort to put a number on what it costs them for an employee to be absent from work, much less what the walking wounded cost. I have come across a few that have, but how they use the information is confusing and often frustrating. One human resource manager/safety director proudly told me that to have one employee (let’s call him Fred) absent from the assembly line for one day costs the company $3,000 in lost product. Fred makes about $10 an hour. I asked the HR manager how much he might be willing to spend to keep Fred healthy, happy, and on the line. He wasn’t interested in spending anything because “we can’t afford it.” Math wasn’t always my strong suit, but like Jethro, I did some quick “ciphering” and estimated that the company had lost about $30,000 that year on Fred alone. It seemed like spending a few hundred dollars through a corporate wellness plan to keep Fred working might have been money well spent.

When companies begin to look at the full cost of lost productivity, benefits programs like health, wellness, and disease management, start to look more like an investment with a measurable return, rather than a cost to be cut. The challenge will be for benefits managers and those providing the services to put lost productivity from poor health into the revenue, earnings and cash flow measurements, whereby financial officers and owners of small businesses can really understand. And the programs must be sound, data-driven programs, while a little less on the intuitive side. They must be programs with measurable outcomes. This doesn’t have to be as complicated as it seems. Most of the metrics are already available, such as the rate of absenteeism, turn-over, healthcare utilization, and profit per employee.

Being healthy hasn’t really changed in the past 30 years. For the most part, people still suffer from the same diseases and ailments they have always had. What has changed is the way we evaluate human capital and how it is expended in the workplace. American companies can’t compete in a global economy on wages, taxes, and the cost of doing business. We stay competitive, only because we have been able to leverage the most productivity out of our workers than anyone else in the world. Whatever it takes to keep people healthy and improve their quality of life, I’m all for it—even if we call it a paradigm shift.