A Common Sense Approach to Report Writing in Occupational Medicine

In occupational medicine, one of the most persistent challenges we face is managing long-term sickness absence, particularly when it relates to mental health conditions such as severe anxiety or depression. While such cases are often approached from a clinical and administrative angle, there is a crucial public safety dimension that is frequently overlooked. In this book, I put forward a compelling argument: that the DVLA (Driver and Vehicle Licensing Agency) medical fitness to drive standards—a well-established but underutilised set of guidelines—can be a valuable tool in assessing fitness for work, especially in cases involving long-term mental illness. The DVLA guidance states that individuals with severe mental health conditions, for example, severe anxiety or depression, must cease driving and inform the DVLA. However, in practice, many continue to drive while being signed off work, often for extended periods. This creates a fundamental inconsistency: if someone is not considered well enough to perform basic office duties, how can they be deemed fit to operate a vehicle—a potentially lethal machine—on public roads? Public safety must take precedence. Driving while mentally incapacitated poses a serious risk not only to the individual but to the broader community. The solution I propose is simple : better integration between occupational health assessments and DVLA fitness-to-drive standards. In my own clinical practice, raising the issue of driving, where appropriate, has served as a strong motivator for patient engagement. Once individuals recognise that poor mental health can also affect their legal ability to drive, they often become more proactive in pursuing treatment and recovery. Moreover, if found to be unfit according to DVLA criteria, their licence should be temporarily revoked until they are declared fit to drive again. This strategy offers three key benefits: 1. Protecting the public: Ensuring unfit individuals are not driving reduces the risk of accidents and injuries. 2. Encouraging recovery: Tying driving privileges to mental health recovery can motivate individuals to engage with treatment. 3. Utilising existing frameworks: This approach is cost-effective, requiring no new laws—just better use of systems already in place. Importantly, this is not about penalising those with mental illness. It is about applying consistent and fair standards that protect everyone. If someone is genuinely unwell, then every facet of their functionality, including driving, must be appropriately reviewed and managed.