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REHABILITATION FROM HEART DISEASE AND WORK: THE ULTIMATE STRUCTURED ACTIVITY?
Now, back to the real world… The programs don’t take up most of your time, and they also don’t go on forever, usually lasting up to a year. Also, in the real world, many have to earn a living. When it comes to work, there may be the risk of “too much of a good thing”?too much activity and too much structure. Thus, vocational rehabilitation can be a key component in the recovery process.
We know that some of those who have had a cardiac event will simply not be able to work?ever (see Rose), at first (see Joe)?or are pushing too strongly to work at the wrong time (see Mary), a type of maladaptive denial. Many patients will be able to return to work, but not all continue to do the same work they did before.
A graded approach to work eligibility is usually required. The question of disability?full-time or part-time, with respect to one’s own job or any job?is complicated by the issue of compensation. If the decision is made by a third party (for example, an insurance company), unfortunately an adversarial situation is often created, in which one party is attempting to disprove something, and another to prove something?and the truth is often in the middle! On the one hand, disability payment can act as an incentive to further improvement and provide important coverage for those who cannot work. On the other, the protection of financial support and the perceived stresses of returning to a job can be a disincentive to plunging back into the competitive world of work. Of course, this is a gray area, and often the emotional side comes into play. In many situations suitability for work becomes a matter of opinion, although some disorders, such as clinical depression, make the decision quite clear. To avoid too much complexity, then, we state the obvious: “You can only do what you can do!” However, even this advice is not entirely straightforward, as you must consider “what you can do.” A combination of objective opinion, honest subjective appraisal and a phased approach is in the patient’s best interest in deciding about returning to work.
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