Capability/dismissal Issue?

[kellemar]

I am new to the forum, but would really appreciate some advice. My apologies in advance because I have put a lot here so that there is a full picture.

 

I work in the NHS as a Secretary and when I joined in 2003 I disclosed that I suffered from back problems and that was fine. I have never lost any time at work for this until recently.

 

Unfortunately as a family we have had a very bad year with the loss of my mother, my husband needing major orthopaedic surgery and then being diagnosed with a really nasty inflammatory bowel disease (not to be confused with IBS). This has necessitated him being hospitalised twice for 2 weeks each since July and the cancellation of a holiday we had booked for a week away as recuperation. On top of this, my daughter has been bullied at work (and she works in the same place as me although not the same department) and this has upset me immensely.

 

In August, I had a disagreement with my Line Manager about a day off and she was shouting at me. I was really upset in the phone call and in tears, but she continued, so I just said, "it doesn't matter" and I put the phone down. I didn't have the day off and continued going in and she didn't come to see me at all.

 

This was on top of quite a lot of another issue that had been going on at work, which was my request to move office to the ground floor because of the amount of medical notes I use (I am currently located on the top floor of the building, up 5 flights of stairs and there is no lift). It was really playing havoc with my back and I didn't want to experience any problems with it, but was having to carry these up and down the stairs. I was told I couldn't move office because the secretary on the ground floor didn't want to move. Instead, she arranged for a clerk to collect the notes for me and take them back. This is okay in theory, but in practice it doesn't work very well. The clerk works 20 hours a week from 8.30 to 2.30 and not on Mondays. QWuite often there are dictation piles ready to collect at 3.30 - 5.00pm or early in the morning and whilst I appreciated the offer, it really doesn't work.

 

Sorry for being so long winded, but in the end, after the phone call with my Line Manager, I felt so wound up and was very tearful. I went to see my GP and he signed me off with stress for 2 weeks. Unfortunately I had been off in February with flu for a fortnight and on returning to work, was told that my Bradford Score was high and that any further episode of sickness would result in there being a formal referral to HR.

 

To summarise, I had 2 weeks off in June with a viral infection/oral thrush - certificated by my GP. 2 weeks in August for stress, certificated by my GP.

 

At the end of September, I was very sick on a Sunday, but went into work on Monday even though I didn't feel great. I didn't each and just sipped water all day. When I went home I was shattered and went to bed. On Tuesday I went into work but felt very unwell. I barely had the energy to get up the stairs and 2 of my colleagues were so concerned about the way I looked that they came and sat with me. After they left my office about 30 minutes later, I took the post down to my consultant's room on the next floor down and came back up with a big pile of medical notes. When I got into my room I was quite nauseous and rushed into the toilet next door and was violently sick.

 

There was no way I could continue at work, so I left at 9.15am and saw my Line Manager on the way out. She was fine and said don't worry about the referral, she just has to do it.

 

Unfortunately when I got home I could barely get out of the car for the pain in my leg and back. It was excruciating and when I got into the house, I took some painkillers and went to bed, but couldn't sleep. I called my physiotherapist and arranged to see them next day. She confirmed a trapped nerve in my lower back and I have now been seeing her for 2-3 times a week since then and I am still off (now 5 weeks).

 

I am seeing my GP this afternoon as although the pain in my leg has gone, my back is very unstable and the physio is working at strengthening the core of the back so that I can sit for a period of time and generally get on with my life.

 

I have spoken to my Line Manager regularly and she told me that she will be making an Occupational Health referral now. I have said that is absolutely fine as I have no problems with any investigations into my health - I am very open and honest.

 

To cut my very long winded story short (and sorry it has gone on), I am concerned that this may lead to them looking at my capability to do my job. I love what I do and want to stay there and I have tried to do everything possible to ensure that my back doesn't impact on my working life. However, if I was on the ground floor, I would not have to lift files up and down stairs and could use the trolley to take them everywhere and no-one else would be bothered. I do realise that what they have done is "make reasonable adjustments" but have they done enough too? Should I be refused a move just because someone else doesn't want to?

 

What is more worrying is that I had my occupational health appointment yesterday at work with an Occupational Health Physician, not the nurses we normally get to see at my grade. He introduced himself and then asked me if I knew why I was there. I said "because my line manager referred me due to my recent absence" and he said "because you are off sick again". He then asked me to explain what happened.

 

I explained everything to him as above. What happened next completely took me by surprise. Let me start by saying that I am not my optimum weight - I am overweight and need to lose a few stone (about 4) - not good I know. However, this is mainly caused by poor eating habits, skipping breakfast and lunch and then just having something light in the evening. I don't do chocolates and the like and don't booze - I had a hormone imbalance when pregnant and then polycystic ovary syndrome so it all complicated things. Basically I'm last on my pecking order, I look after every thing and everyone first and I come last. Sorry I'm ranting because I feel I need to justify myself.

 

The doctor's response was that my back was causing me a problem because I was overweight and didn't exercise enough. He said it was the equivalent of him walking around with a 10 stone rucksack on his back. He added that my back pain is just 'mechanical' and there's no reason why I couldn't work. I should expect pain and discomfort, but I had to work through it. He then went on to say that if I lost 40kg and exercised a lot, I wouldn't have any problems and my back would be in the same condition as any other person of my age. At this point, we were still sitting discussing my back and the problems I was having - he had not examined me nor weighed me.

 

I then said that I had avoided lifting and carrying even remotely heavy things because of the risk of injury to my back and he said I shouldn't do that - in fact he advocated that I should do it more as it was the only way to increase my 'core stability'. I asked about carrying the files from the main hospital to my building and then up and down 4 flights of stairs and how the weight and the stairs aggravate my back. He said I should do more of it. In fact he said that if the files weigh 20kg, I should split it into 5kg bundles and make the trip 4 times. He also added that I may wish to take painkillers on a regular basis so that I could do all this without experiencing much pain or discomfort.

 

He further advocated that carrying weights, walking past pain, cycling and going up and down the stairs won’t do any harm to my back and will strengthen it. He said I cannot 'hurt' my back and the more I do it the better it will get. I will, of course, have to get used to the pain and discomfort.

 

I pointed out that I was away from work due to the recommendation of my physiotherapist and my GP agreed with this. He said that they could just say "wait another 2 weeks" each time and it would be a year before I went back to work. I politely said this wasn't the case and I had been querying when I could return at each visit to my physiotherapist and that she had said she felt I could return next Monday, but on a phased return basis, i.e. less hours. He said it wasn't up to her.

 

I said I hadn't had an episode of back pain so severe since I first experienced the pain in 1998 and I did normally cope with day-to-day back 'twinges' and 'electric shock' type symptoms, but I could not cope with this acute pain which the physiotherapist said was a trapped nerve. He said he doubted this.

 

He then asked to examine my back (and I was fully clothed). On feeling parts of my back and asking if I had pain, when he reached the area of pain (at the very base of my spine) and pressed it, I said it was there and he said 'that's muscle pain'. He was very clearly pressing on my lower spine, but called it 'muscle pain'. He then moved to the left which was painful.

 

He said I had the ‘stiffest back he had ever seen’. I had no rotation in my back when he asked me to twist my shoulders around to the left and right. I added that it had been previously reported that I had a lack of normal spine curvature and he said 'no, you have a normal shaped back and spine'.

 

He said there was no reason why I couldn't go back to work on Monday (or tomorrow if I wanted) and proceeded to type the report for my line manager. In it, he put that if I lost a lot of weight and did more exercise, that I would not experience pain in the future. He advocated a return to work on Monday on a phased return for 2 weeks (half normal working hours) with full-time after 2 weeks.

 

I am really concerned about this because he didn't ask me anything about my back problem, any diagnoses received, etc. I have previously seen a Consultant Spinal Surgeon/Neurosurgeon who found bulging discs at the base of my spine. In addition, there is marked degeneration of the discs and a significant loss of disc space. This, my physiotherapist advises, is what causes the nerves to get trapped and the pain to become quite bad because the facet joints end up getting irritated. (I have previously been admitted to hospital for injections into the spine to relieve symptoms and provide a window for intensive physiotherapy, but this was short lived). In addition, I have been told to avoid lifting or any twisting movements and in general, anything which is likely to irritate my back. If I experience pain, I am to do exercise up to the limit of the pain, ice my back regularly and undertake intensive physiotherapy (which I do). In general, I follow professional advice to get myself mobile and active again.

 

Of particular concern here though is what he has written in the report. He has said about my weight and lack of exercise being the problem and then added that I should carry files up and down the stairs often. This is going to my line manager. If, at any point in the future, I injure myself doing this or cause problems for my back, it would appear to me that my line manager will say "it is because you are overweight and don't exercise enough" and thereby, it will be my fault. Would this be a correct interpretation? This therefore also raises the question as to my future employment ... and my capability. In fact, having spoken with Acas, they feel the employer could be going the dismissal route and advised me to speak with a union rep urgently.

 

As you can see, there is loads going on in my head and it's taken me some time to calm down after this appointment (and immediately type up everything I remember from the appointment). I really need some advice and help.

 

In the interim, I have contacted my GP (who is appalled by this) and my physiotherapist (who is furious) and the physiotherapist is going to write a report for my employer. My GP advocated that I contact my consultant for his written report too so that I have documentary evidence of my back problems. Excellent advice I thought. I need to know if I need to do anything else. The last thing I want is to go back to work expected to do these things when they cause acute pain and irritation. If it were to make my back symptoms worse, I think I would then be dismissed under capability grounds and because I was overweight and in need of exercise. I need to know what I need to do and what you think is going on here.

 

Thank you so much for reading this short novel (!) and for any advice and help you can give.

 

I am feeling really stressed and anxious again after all of this, haven't slept much and am feeling quite tearful again. I really don't need all of this again with everything else that's going on.

 

Thank you.

[reallymadwoman]

I can't offer more than my sympathy, but I actually think you're doing all that you need to do at the moment anyway.

 

I wish you luck and hope your back improves. One thing I can confirm, having being diagnosed with an 'unstable disc' and having had physiotherapy - I was told that if it hurts, stop immediately. Pain is not to be got through, it is the body's way of telling you there is imminent danger of an injury.

[Lula]

Are you a member of a union? if so I would suggest that you contact them immediately, print out your report above and show them.

[kellemar]

Thank you both for your responses and for reading my long blurb. Yes I am a member of a union and I have spoken to them. They have said his name has come up before.

 

My physiotherapists think that he has written it on the basis that I have chronic back pain, which I do and which I manage on a day-to-day basis with exercises and physiotherapy when required. What he has not taken on board is that this was an acute episode whereby I could barely walk and couldn't even get upstairs.

 

Fingers crossed, but just wondering whether I should just quit. This whole thing has caused me an anxiety attack and I feel very low, demotivated and that my reputation and integrity is in question. Does a person who swings the lead pay for their own physio 3 times a week to get them back to work asap? I don't think so.

[reallymadwoman]

Do not quit. Do not even think about quitting. Why should you let one insensitive person drive you from a job you love?

[oojakapipi]

Can you get a letter from your Consultant confirming the previous diagnosis/treatment? If so you should send it to the head of OH or your manager (keep a copy), not the physician who examined you. You also need to find out if you are covered under DDA for your condition, so a long term prognosis from the Consultant may help establish that.

 

I am shocked that he has used your size as an excuse for your recent problems. I have the same low back problems and have always been a 'correct' weight and exercise regularly, this has not prevented extreme spasmodic and sciatic episodes over the last 10 years often without warning. Those of us that live with this problem know what relieves it, listen to your body and advice off your (obviously trusted) Physiotherapist.

 

Please don't let this physician undermine your confidence and make you feel you have to resign.

 

Best wishes.

[kellemar]

Thank you both for your replies. I have spoken to my line manager and she has been surprisingly supportive and said the letter had rather more information than she needed. She just wanted to know if I was able to come back to work.

 

That doesn't excuse the fact though that he has caused me extreme anxiety. I had to see my GP yesterday because I am in tears, shaking and feeling very low and emotional. He prescribed Diazepam to help calm me down. After the phone call to my line manager, I was feeling good and positive about going back, but awoke this morning with all the symptoms and they aren't going away - I am furious and very upset.

 

I am going to try and go back to work on Monday and hope that these symptoms resolve by then. If he had even read that I had been off with stress previously and what had been happening in my life in the last year, he may have had an indication of what his comments and letter might do to my emotional wellbeing, but he didn't ... or he did and didn't care. I'm trying to cope at the moment with my husband again being hospitalised for the 9th time in less than a year and my daughter having been bullied and harassed at work since joining this NHS Trust in January and a complaint ongoing. It really isn't doing anything for my health.

[Lula]

It must be a truely terrible time for you, but even though your boss said that this is more than she needed, this is now on your permanent record and that is where is can cause the most damage.

[kellemar]

It is a vile time for me Lula - for all of us really. In truth it has been the worst 18 months of my life because I suffered the loss of my mother suddenly just before Christmas too. All in all I didn't think things could get worse. I am tired of it all and want it all to go away, but it isn't that simple. If it continues I can either "fight" or "take flight". I will have to let my own health dictate to me what route I take if and when I get to that stage.

 

I have written a letter of complaint and am just waiting to run it past the union rep so that he can okay it.

[Lula]

It sounds bloody horrible, but all I can say is that you will feel better for fighting it, maybe not today , maybe not tomorrow. but soon (LOL can't resist a great quote!) there are loads of people here that are experts on employment law and can help practically, the rest of us will support you as long as is required. XX

[kellemar]

Thank you so much xx

[oojakapipi]

Apparently a symptom of stress can be back problems so hopefully your GP's treatment of the stress will help with your symptoms. Interestingly, I was prescribed Diazepam once for back problems, so I just looked it up on the web and it is used for anxiety and to treat muscle spasm!

 

The physicians comments about your size were unhelpful and as I was trying to point out earlier, he would not be able to use the same excuse with everyone who has the same back problems. He would have to look deeper for a 'cause' and should have done the same with you.

 

Put it another way, if you had been sent to him for being off too many times with colds he could decide you don't eat enough oranges (therefore blaming your lifestyle), instead of recognising that you are also suffering stress and advising you to seek treatment.

 

I hope you are able to dismiss this man from you mind as his advice on working through the pain is seen as wrong by the people who have been treating you, so his assumptions about the cause of your problems should also be treated as rubbish. Your GP and Physio both sound great.

[kellemar]

Thanks Oojakapipi. My GP has prescribed Diazepam for anxiety and I found out about its use for back problems when they started because I was on them again. They were very helpful because they do make you relax (and sleep) and that was one of the best remedies in the beginning because when I was asleep I wasn't conscious of the pain.

 

I am very concerned about this doctor and his 'opinion'. If people were to take his advice they could do themselves a lot of damage and hence I will be writing a complaint letter about him. I feel he needs to learn how to deal with patients and look at their entire health before making very unhelpful, negative and downright demeaning comments about people. If he was worth half his salt, he would have done that before he saw me.

 

My physio and GP are great, although I think my GP despairs of me sometimes because I do struggle to cope when there's just too much going on. It's okay in one place (i.e. home with my husband being ill and losing my mum) but when I get it at work as well I struggle.

[oojakapipi]

The fact that you have been off with stress before and are now being treated for the same problem should make the inadequacy of his report obvious to anyone. Thankfully your back problems are not new to you and you have the benefit of past experience, but as you say someone else without that experience might just take what he says as 'law'.

 

Don't forget about DDA, as you may be covered and as such have the right to ask for reasonable adjustments. It sounds like your employer has tried to help by getting someone to carry the notes you need but as you said, it is not working and needs looking at again.

 

I'm glad you find Diazepam helpful, I couldn't take it as it made me feel very sick!

[kellemar]

I'm really worried about going back now because I am in full blown anxiety attack. I've got the shakes really bad in the mornings and I can't sleep. I really don't know what to do and I'm so upset about it

[reallymadwoman]

Go back to your GP immediately. If you feel your line manager will really be supportive it might be worth speaking to her too.

 

Forcing yourself to go back to work on Monday in this state will be counter-productive and will only make things worse - at least in my experience. I went through three months of forcing myself to keep going and ended up having a complete breakdown and losing my job anyway. I should have sought help immediately.

[kellemar]

I saw my GP on Wednesday and was in a state when I saw him. I am still certificated until Tuesday so hope that I will start to feel better, but I'm afraid I'm feeling a bit lost about it at the moment. I do agree with you that forcing myself to work in this state will be counter-productive; I have tried to do it before and was shaking and crying and feeling extremely nervy so I have no inclination to do it again.

 

If I cannot make it on Tuesday I will ring my GP and get a certificate. At the end of the day, if I cannot work because of ill health, that's it. The last 12 months have been the worst of my life and it just seems to continue ... I just want it all to go away.

 

At the moment, I'm just really looking forward to my husband coming home this afternoon ... can't wait. Hopeful that this will make a huge difference as he certainly doesn't need this. Neither does my daughter (23) who has been brilliant and so supportive, but of course it's having an impact on her too, although she doesn't show it.

 

Thank you for your advice and support.

[skonk]

I'm sorry I can't help with the job situation, and in an ideal world, we'd all love to be our ideal weight, but lifestyles work differently for different people, and our weight is the one thing that varies.

 

Have you ever tried acupuncture for your back? I was involved in a car crash a year and a half ago, and all the pain was in my lower back, and my physio asked if I wanted to try acupuncture. I was wary, but said yeah, anything to help the pain. Had quite a few sessions, and it helped me so much. It doesn't hurt, only a few moments of discomfort and that's it.

 

I hope everything works out for you though.

[kellemar]

Hi Skonk. As you say, in an ideal world, everything would be just how we want it, but life isn't like that is it.

 

I have tried acupuncture, yes. It's the method the physios use when the pain isn't intense and they use it in combination with interferential, massage, trigger point techniques, etc.

 

I saw my consultant this morning and he wants another MRI and then to see me again next week. He wants to check the discs haven't degenerated any more (and he confirmed that prolapsed/bulging discs are seen on old scan at L4/L5 and L5/S1). After that, he will decide the best course of treatment. Isn't it typical though - I just hate MRI scans because they are so claustrophobic and I suffer with stress and anxiety!

[kellemar]

Had the results of my MRI scan and they confirmed that I had prolapsed another disc in my back at L3/L4, just above my problem discs of L4/L5 and L5/S1.

 

Back at work for a month now and my colleague in the office isn't speaking to me unless it's about work ... don't know what that's about as we get along really well and all was fine before I went off sick.

 

My husband is acutely ill now and has just had major surgery - I was due back today but he needed his staples out so I had to take him for that and asked for a day's carer's leave because he also needed a scan on his leg following a visit from the emergency doctor yesterday. That has confirmed a DVT and he now needs to take injections and medication for that.

 

I mentioned this to my line manager on the phone this morning and said I think I need to take a week off to look after him, to which she responded that I should have enough annual leave for that. The two young girls in my office use their whole 10 days carer's leave every year because their sons need to go to the dentist, or feel unwell, but I seem to struggle for everything.

 

I feel the need to walk ... a long way ...