Work and the Pursuit of Happiness

08/07/2015

Written by Maja Jurisic MD, VP, Medical Director National Accounts | Published on August 7, 2015
Medically Reviewed by Katherine Kreis MSN RN on August 6, 2015

As an occupational physician, I take care of patients who do all types of work. And what I have observed over the years (and what many studies have found) is that job satisfaction is the most important factor correlating with an early return to work after an injury or illness.

Perhaps, this should not come as a surprise. We live in a country founded on the principle that all people are entitled to life, liberty and the pursuit of happiness. And yet, as psychiatrist Viktor Frankl wrote, “Happiness cannot be pursued; it must ensue.”

Where or how happiness ensues is the topic of much discussion. Money and an abundance of material goods do not pave the way to happiness; rather, finding meaning in one’s work and life is the avenue to that destination.

Everyone from Albert Camus to Jose Ortega y Gasset has weighed in on the central importance of work to human existence. Camus said, “Without work all life goes rotten.”

Ortega y Gasset’s words were “An unemployed existence is a worse negation of life than death itself. Because to live means to have something definite to do- a mission to fulfill- in the measure in which we avoid setting our life to something, we make it empty.” Victor Frankl, whom I’ve already quoted, believed that the motivational engine powering human existence was the search for meaning and purpose in life.

In my practice, I avoid putting someone “off work” whenever possible, not because that’s what the employer wants, but because I believe it is in the best interest of the employee, my patient, to remain in the workforce.

While “off work,” individuals suffer the loss of social relationships with co-workers, the self-respect that comes from earning a living and the sense of identity that comes from their occupation. Compound these psychological negatives with the fact that the decrease in physical activity, which often accompanies being off work, results in loss of muscle strength and tone, and you have a prescription for a bad outcome.

The odds of a worker ever returning to work drop 50 percent by the twelfth week of being off work. That is perhaps one of the reasons that our current practice of focusing disability management efforts on those who are out of work (and who often have already been out of work for some time when we initiate these efforts) so rarely succeeds.

Professional medical organizations strongly recommend that physicians return patients to their usual work roles as soon as possible. A consensus opinion statement from the American College of Occupational and Environmental Medicine (ACOEM) reads, “Prolonged absence from one’s normal roles, including absence from the workplace, is detrimental to a person’s mental, physical, and social well being.” The American Medical Association, the American Academy of Orthopaedic Surgeons, and the Canadian Medical Association have also all said pretty much the same thing.

A review of the medical literature supports the fact that being out of work is hazardous to one’s health. A 1995 Canadian review of 46 articles concluded that unemployment has a strong positive correlation with many adverse health outcomes. It was associated with increased overall mortality, as well as mortality from cardiovascular disease and suicide in particular. Swedish data reported in 2001 showed that unemployment was associated with a higher relative risk of mortality, even when controlled for potential social, behavioral, work, and health-related confounders.

A study reported in 2002 looking at Danes showed that those who were healthy when they chose an “early” retirement had a mortality rate showing an adverse effect on health from retirement itself. In 2003, a report describing the mortality experience of 30,000 Swedes, followed up for 10-17 years, showed that unemployment increased the risk of death by nearly 50% (from 5.36% to 7.83%).

ACOEM has published a guideline called "Preventing Needless Work Disability by Helping People Stay Employed.”* This guideline focuses on those individuals with “preventable disability.” It looks at the roughly 10% of the working population who end up withdrawing from work for prolonged periods of time (or perhaps forever), after a relatively minor work injury or problem. As one might imagine, this scenario has unfortunate consequences for the employer, the employee, and society in general. Sadly, all too often, this outcome could have been avoided.

One of the reasons this happens is that many well-meaning people involved in the workers’ compensation system do not realize the potential harm resulting from prolonged medically excused time away from work. As the ACOEM guideline points out, “Many think that being away from work reduces stress or allows healing and do not consider that the worker’s daily life has been disrupted. With these attitudes system-induced disability becomes a significant risk.”

The average physician who treats adults signs five or more work-related notes or letters every week. Yet, few physicians (besides occupational physicians and physiatrists) receive training in disability prevention and management. In a book titled A Physician’s Guide to Return to Work, Dr. Mark Melhorn notes that 60-80% of lost workdays involve medically unnecessary time off from work. The most common reason physicians gave for putting patients off work was an unwillingness to “force a reluctant patient back to work.”

Other reasons included being ill equipped to determine the right restrictions, feeling caught between an employer’s and an employee’s version of events, and employers being unable to provide modified duty.

So, let’s get back to work and the pursuit of happiness. My experience has been that people are happier when they feel they are contributing something with their work, whether it be in the home, or in a workplace out in the wider world. My 91-year-old grandmother, a hard worker all of her life, clung to doing the dishes until almost the very end. The last few weeks, when she was too weak to perform household chores, she expressed unhappiness at being unable to pitch in. My  father, a psychiatrist who certainly didn’t have to work any more, chose to do so until he died at age 90 because it gave him the opportunity to do something of value for other people, and it made him happy to help.

The medical mantra these days is that we should practice “evidence-based medicine.” Basing treatment on anecdotal experience or providing “customary and usual care” is considered bad form if it clashes with evidence-based recommendations. Yet, being human, we are uncomfortable with cognitive dissonance, and no matter what evidence-based studies tell us, if they don’t mesh with our experience, we tend not to embrace the “scientific” evidence. Scientists over the centuries have faced this when proposing new theories that ran counter to the prevailing wisdom.

Fortunately for me, what I am inclined to do based on my own experience (keep patients working and thus give them the opportunity to pursue meaning and happiness) fits perfectly with the evidence-based data.

There are documented benefits to staying at work and being active. Studies have repeatedly shown that workers receiving disability benefits recover more slowly and have worse clinical outcomes than those with the same medical conditions who don’t receive disability benefits. Studies have also shown that recovery is hastened by activity and delayed by inactivity. Thus, the ACOEM guideline recommends shifting our focus from managing disability to preventing it. It urges revamping the disability benefits system to reflect the reality that resolving disability episodes is an urgent matter. We have a relatively short window of opportunity to re-normalize an injured worker’s life and keep that individual from functioning in a “sick role” for so long, or so repetitively, that he or she becomes a professional patient.

It is important for everyone involved - physicians, injured workers, and employers--to realize that, in most cases, absence from work is neither medically required, nor in the best interests of the patient. Education of more physicians regarding the nature and extent of preventable disability, education of patients about the fact that activity is helpful during recovery, and improvement in employers’ willingness to provide modified work, could each have beneficial results. If we acted to make all of these things happen, the benefits could be powerful indeed.

* Reducing the Burden of Work-Related Injuries and Illnesses. (2006, September 1). Retrieved August 7, 2015, from http://www.acoem.org/guidelines/article.asp?ID=100