Disability prevention principles in the primary care office

The simple request for a sick note can disguise important medical, psycholo gic or social issues. Disability may be influenced by social and cultural f actors as well as by patient expectations. Assessment of impairment and sub sequent disability is best made on the basis of objective data by use of a biopsychosocial model to ensure that the expression of disability does not mask other unaddressed psychologic or social issues. Enabling prolonged dis ability in such a situation can be a dysfunctional physician response to a maladaptive process. The physician's role is to treat the condition, to ful fill the appropriate role of patient advocate, to facilitate health (includ ing resumption of activity), to offer proactive advice on the basis of prog nosis, to be familiar with the patient's social obligations and resources a nd to provide education about the therapeutic benefits of returning to opti mal function. This factual, medical-based approach offers an effective prev entive strategy that will save many patients from unnecessary disability an d morbidity.