Long-term sickness absence is costly for employers, workers and society in general. Besides the economic benefits, enabling timely rehabilitation of employees back to work is also intended to improve their physical well-being and self-esteem.1 One of the measures recommended in the Black Report to help achieve these aims was the introduction (in the UK) of the ‘fit-note' in 2010.2 This fit-note was intended to replace, at least in part, stark statements that a worker was too ‘sick’ to work by qualified statements of fitness provided certain reasonable workplace adjustments (such as a graded return to work) were made.

The paper by Gabbay et al3 evaluates the effects of the introduction of the fit-note by examining sickness absence data collected in two separate studies, separated by a decade, and conducted before and after the introduction of the fit-note. The comparison was based on seven general medical practices which were common to the two studies of a larger set of 68 UK practices.4 Gabbay et al showed an increase in the total number of certificated absences issued in the seven common practices after the introduction of the fit-note, and especially an even greater increase in the number of those certificates …