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At medical school, all doctors are taught that at least 80% of the information you need for a diagnosis will come from the symptoms the patient tells you about, with only 20% coming from a physical examination.1 The same is true in assessing a person’s fitness to work. Mostly, if I’m told that a patient’s anxiety related insomnia is making it impossible for them to concentrate, or that their low mood and intrusive thoughts of self-harm mean that they struggle to get out of the house each day, I believe them. Of course, it’s possible that I’m sometimes misled, but my starting point must be one of trust: if I don’t trust my patients, why should I expect them to trust me? And without this mutual trust it’s hard to do medicine well.