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Fluctuating Conditions


Fluctuating conditions are those which do not follow a stable pattern of disability or illness or cause a fixed level of impairment.  They are generally systemic and cause a varying impact on an individual’s ability to function. This encompasses relapsing and remitting conditions

Fluctuating conditions present unique challenges.  Challenges to the person with the condition, to their employers, to onlookers and to policy and legislation makers.  If the condition is also invisible, these challenges are often even greater

The challenges of having a fluctuating condition can be difficult to appreciate for those other than the sufferer.  So, consider the following...

You're an ST2 who works in Medical Assessment.  It's Bank Holiday.  Yesterday evening you developed mild gastroenteritis.  You rang HR who said absence will cause short staffing and they need you in if possible.  You feel okay, so you go to work...

At work you vomit and feel more unwell so leave.  You feel guilty for leaving colleagues on such a busy day but you have no choice...

You take 2 days off and go back before you are fully recovered.  You spend the next week at work feeling fatigued and unwell and cover an extra on call for a colleague who came in to cover your absence

Green pharmacy sign
 Young Woman Contemplating

Now imagine this happening every few weeks...

For those of you who know exactly what it is like to have a fluctuating condition, you will most likely recognise the spiral of fluctuation.  It can be helpful to utilise this diagram when seeking support from Occupational Health or colleagues to help explain the effects of this repeating cycle

: Spiral of Fluctuation

So what do you do if you have a fluctuating condition as a doctor? 

We have a document that is packed full of good advice, tips and references to other relevant resources


Much of the content is also relevant to older doctors too

Download it now for content on:

  • Definitions of fluctuating and relapsing/remitting conditions

  • The size of the problem at work

  • Obtaining reasonable adjustments

  • Considerations when requesting reasonable adjustments

    • Flexibility in your rota​

    • The Bradford Formula/Factor

    • Adjustment implementation

  • Specific condition related challenges​

    • Invisible and fatiguing conditions​

    • Conditions of minimal severity

  • Summary of current difficulties for doctors with fluctuating conditions​

  • Summary of key advice

Fluctuating Conditions

Section author - Dr Sara Booth

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