LFOM Written common mistakes
LFOM Written · Understand the traps and how to avoid them.
When asked to assess fitness for work, the candidate writes a diagnosis-led answer (naming the condition and saying 'fit with restrictions') without stating the specific functional demands of the job and whether the worker can meet them.
Candidates default to clinical reasoning learned in hospital practice, where the diagnosis drives management; occupational medicine reverses this, starting from the job's demands and the workplace context, and this inversion is not intuitive under time pressure.
What to do instead
Before writing, list the job's physical, cognitive, and psychosocial demands explicitly, then map each to the worker's capacity, and phrase the opinion as 'can/cannot perform demand X, with adjustment Y'; practise this template on three common scenarios (manual handling, shift work, respiratory sensitiser exposure).
The candidate attributes symptoms to work whenever the worker believes the job is responsible, without systematically considering non-occupational causes or applying a structured approach to causation.
Empathy and the worker's narrative pull the candidate toward agreement, and occupational medicine's bidirectional reasoning (work causing disease and disease affecting work) is unfamiliar, so anchoring on the patient's attribution goes unchallenged.
What to do instead
For every causation question, write out both differentials (occupational and non-occupational), state the exposure evidence needed to support or refute work-relatedness, and use a recognised criteria framework (temporality, dose-response, plausibility, consistency, resolution on removal) rather than a single clinical impression.
The candidate gives a blanket 'unfit for all work' or 'fit for full duties' opinion when the scenario calls for a graded, time-limited opinion with specific adjustments and a review date.
Binary fitness judgements are quick and feel decisive, and candidates fear that nuance looks indecisive; they also forget that fitness opinions are usually provisional and should be revisited.
What to do instead
Always include three elements in a fitness opinion: the functional conclusion (what duties, with what restrictions), the duration (temporary/permanent, review date), and the basis (what information it rests on); if information is missing, state the opinion is provisional pending specific further information.
The candidate discloses detailed clinical information to a manager or in a report without first considering whether the recipient needs it, and without seeking the worker's consent to that level of disclosure.
Candidates equate a full clinical picture with a helpful report, and the duty of confidentiality to the worker competes with a perceived duty to the employer that candidates over-weight.
What to do instead
Apply the minimum-necessary principle explicitly: separate the clinical record from the management report, describe functional impact rather than diagnosis where possible, and state in the answer that consent was sought and what was agreed; if consent is refused, describe the limited options available.
The candidate treats consent as a one-off signature and proceeds to examination, testing, or report release without addressing capacity, voluntariness, or the worker's right to see the report before it is sent.
Consent is taught as a formality in undergraduate training, and the specific occupational health consent model (including access to reports and consequences of refusal) is not reinforced in general clinical practice.
What to do instead
In any scenario involving examination or disclosure, explicitly check four things in the answer: that consent was informed, that it was voluntary (and what happens if refused), that the worker has been told what will be shared and with whom, and that the worker's right to access the report has been explained.
The candidate advises on a legal question (e.g. whether an employer must make a reasonable adjustment, whether a condition is reportable, whether dismissal is fair) by asserting a conclusion without identifying the legal framework or acknowledging the limits of their role.
Candidates conflate clinical expertise with legal authority and want to give a definitive answer; the boundaries between occupational physician advice, HR decision-making, and legal determination are not always clear in training.
What to do instead
Frame advice as clinical input to a decision made by others: name the relevant framework (equality/disability legislation, reporting duties, health and safety duties), state what the clinician can and cannot determine, and recommend the decision-maker obtain legal advice where the question is genuinely legal.
The candidate designs or evaluates a health surveillance programme by listing tests (e.g. spirometry, audiometry, skin checks) without linking each test to a specific identified hazard, a valid test with acceptable sensitivity and specificity, and a defined action on abnormal results.
Surveillance is often memorised as a list of tests per hazard, so candidates reproduce the list without the underlying logic of fitness for purpose, and forget the action-on-result component that makes surveillance meaningful.
What to do instead
For any surveillance question, structure the answer as: hazard identified, valid test chosen and why, frequency and target population, referral threshold, and the action taken when results are abnormal (including removal from exposure and review); explicitly exclude tests that are not validated for the purpose.
The candidate answers a service-delivery question (e.g. setting up a new occupational health service, auditing provision, or responding to a commissioning request) with clinical content only, omitting governance, staffing, record-keeping, quality assurance, and outcome measures.
Clinical training rewards clinical answers, and the managerial and quality dimensions of occupational health practice are less familiar, so candidates under-rehearse them.
What to do instead
Keep a standard service-delivery checklist in mind (need assessment, staffing and competence, policies and audit, confidentiality and record systems, key performance indicators, review cycle) and apply it to any service-design or evaluation question before writing.
The candidate recommends a single intervention (e.g. a training session or a leaflet) as the response to a workplace health problem, without addressing the hierarchy of controls or the organisational factors driving the problem.
Individual-level interventions are familiar and easy to describe, while organisational and engineering controls require the candidate to reason about the workplace system, which is less practised.
What to do instead
For any workplace intervention question, work down the hierarchy of control (eliminate, substitute, engineering, administrative, personal protective equipment) and state where the proposed intervention sits and why higher-level controls were or were not feasible; include organisational factors such as workload, shift design, and management practice.
The candidate writes a report that presents conclusions and recommendations without distinguishing observed facts, the worker's account, and the clinician's opinion, and without stating the sources and limitations of the information.
Clinical notes blur these categories, and candidates transfer that habit into formal reports where the distinction carries legal and professional weight.
What to do instead
Use a fixed report structure: sources of information (and what was not available), factual findings, the worker's account clearly attributed, the clinician's opinion, and recommendations; state limitations explicitly, and avoid asserting as fact anything that is only reported by the worker.