We separate medical need from personal want and illness from illness behaviour. We explore non-medical barriers to work and discuss these frankly with the employee. Where we can we suggest strategies for managing disillusion, anger, sadness and victimhood. A surprising number of employees have health conditions which could be managed better: we advise on additional treatments which could be considered – be it stress, back pain, heart disease or diabetes. And we look outside of the medical model, building confidence and self-reliance. We encourage early referral – especially where managers anticipate medical problems worsening or attitudes hardening. Often we can turn problems or attitudes around before positions become entrenched. All our reports are designed to be stand-alone documents giving all the information managers should need at that time to manage situations thoughtfully, fairly and firmly without having to look back to previous recommendations.