miller Health Occupational Health and Fitness

Index

48. Results DRTPAIS - March 2007

Click here to read what people thought about the program.

Click here to go to Fit and Healthy online, our seminar participant website, full of useful information.

John Miller presented a one day Seven Habits of Fit and Healthy People for The Organisation in March 2007.

Participants completed the following profiles

■ Mind and Body

■ Fitness

■ Musculo-skeletal risk

■ Diet

■ Chemical intake

■ Stress

■ Career Satisfaction

The results are presented in graphic format. Along with commentary and recommendations this report forms the basis of a Workplace Health Climate Survey.

CONTEXT

The health assessment program conducted by Miller Health is based on the premise that the health of key body systems depends on

• physical fitness

• diet

• the avoidance of a toxic environment and

• an ability to manage the stress of both life and work.

Within the Australian community, there is currently an epidemic of body system dysfunctions which when translated into the workplace are associated with increased absenteeism and workers compensation, and decreased work performance and productivity.

There are very few organisations that are immune from this epidemic.

THE PROGRAM

The program included a series of lectures and assessments, taking an holistic look at health, and based on the premise that the major systems of the body maintain healthy function when they are supported by

n	a physically active way of life

n	management of stress, both that which is generated internally and that which impact on each individual from their external environment

n	work satisfaction, including work stress

n	a life in balance in which people have interests outside of work, which distract them from being busy and miserable and stimulate the parasympathetic nervous system.

n	Meditation

HEALTH PROFILES

A number of profiles were used as a means of obtaining a snap shot of people’s health, fitness and stress levels. In the workplace it is also a good measure of the risk of absenteeism, presenteeism and workers’ compensation.

People in poor shape experience

• headaches

• poor sleep

• lack of energy and vitality

• musculo-skeletal dysfunction

• frequent colds and flu

• obesity

• anxiety ...

Sample

Because of the size and nature of the sample selection, it is probably inappropriate to make organisation-wide generalizations about health and fitness.

OH&S risk management

Overall we rated the health of the group as average.

The aging population

I hold to the belief that, barring disability, there are few things stopping people of working age from being in good physical condition. It's not so much that we have an aging population as an unfit population.

The governments of Australia base their medical system data on the premise that it is because people are getting older that they are becoming increasingly dysfunctional. They haven't factored into the equation the fact that people are becoming increasingly dysfunctional at a younger age.

It's a poorly researched premise.

Down at the Productivity Commission and over at the Australian Institute of Health and Welfare (AIHW) they're betting on when the percentage of GDP poured down the medical black hole will reach 15%. It's the cause of great hilarity. According to their latest report, the AIHW even believes the 'health of Australians is getting better'. Hello!

While workplaces have become safer, they've also become unfitter and unhealthier compared to an earlier generation.

In our culture it's a big ask expecting to stay healthy without keeping yourself fit and it's an even bigger ask expecting to get better by having someone do something to you; sooner or later you have to do something to yourself.

Whilst we can expect people over the age of 70 to start slowing down, it is not necessarily the case for people of working age. As a general rule, poor health and body system dysfunction is not so much related to age as it is to

▪ a toxic environment

▪ low levels of physical activity - in particular sitting down all day

▪ diets high in energy and low in essential nutrients

▪ diets loaded with food additives, sugar and aspartame

▪ over-consumption of alcohol

▪ smoking

▪ an inability to handle the normal stresses of life

▪ a job that does not suit their personality, intelligence strengths or interests

▪ an over-reliance on junk medicine - medicine that is pharmaceutically based and which masks

symptoms without stimulating the body's own recuperative power.

Whilst what's actually going wrong may be hard to determine, it's the symptoms that suggest something is indeed going wrong somewhere inside (and on the surface) of your body.

SYMPTOMS OF METABOLIC DYSFUNCTION

The symptoms of metabolic dysfunction are growing by the month. They include

▪ getting fatter

▪ headaches and migraines

▪ tiredness

▪ anxiety and depression

▪ diabetes

▪ high blood pressure

▪ elevated cholesterol levels

▪ cardiac insufficiency

▪ irritable bowel

▪ asthma

▪ poor sleep

▪ snoring and sleep apnoea

▪ rashes and itchiness

▪ attention deficit

▪ ...

(On top of that is musculo-skeletal dysfunction, caused by tight and weak muscles dragging bones out of alignment.)

MIND AND BODY PROFILE

The Mind and Body profile provides people with a very good idea of how well the various systems of the body are functioning, particularly the

• the mind

• autonomic nervous system

• immune system

• digestive system

• circulatory system

• elimination system

• musculo-skeletal system.

On this profile, the lower the score the better.

To complete the profile, circle the number appropriate to the degree to which you experience the symptoms on the left hand side of the page. The greater the symptom, the higher the score.

	Symptom	None		Not much			A fair bit			A lot
1.	Headaches	0	1	2	3	4	5	6	7	8	9	10
2.	Migraines	0	1	2	3	4	5	6	7	8	9	10
3.	Lack of energy and vitality	0	1	2	3	4	5	6	7	8	9	10
4.	Candida - jock itch, thrush, tinea ...	0	1	2	3	4	5	6	7	8	9	10
5.	Poor sleep. If on tablets score 10	0	1	2	3	4	5	6	7	8	9	10
6.	Snoring &/or sleep apnoea.	0	1	2	3	4	5	6	7	8	9	10
7.	Crook back, sore shoulders RSI ...	0	1	2	3	4	5	6	7	8	9	10
8.	Frequent colds, flu, sinus	0	1	2	3	4	5	6	7	8	9	10
9.	Unsettled stomach, reflux	0	1	2	3	4	5	6	7	8	9	10
10.	Irritable bowel, constipation, trots ...	0	1	2	3	4	5	6	7	8	9	10
11.	Overweight - 1 point for every 2Kg	0	1	2	3	4	5	6	7	8	9	10
12.	Asthma	0	1	2	3	4	5	6	7	8	9	10
13.	Low level of aerobic fitness	0	1	2	3	4	5	6	7	8	9	10
14.	Chest pain, palpitations	0	1	2	3	4	5	6	7	8	9	10
15.	Rashes, itchiness, psoriasis, zits	0	1	2	3	4	5	6	7	8	9	10
16.	Mouth ulcers, cold sores	0	1	2	3	4	5	6	7	8	9	10
17.	Elevated blood pressure. Score 0 on pills	0	1	2	3	4	5	6	7	8	9	10
18.	Reduced libido	0	1	2	3	4	5	6	7	8	9	10
19.	Shakes, nervous ticks, mannerisms	0	1	2	3	4	5	6	7	8	9	10
20.	Grinding teeth	0	1	2	3	4	5	6	7	8	9	10
21.	Alcoholic drinks per day (2 pts/drink)	0	1	2	3	4	5	6	7	8	9	10
22.	Smoking. (1 pt/cigarette/day)	0	1	2	3	4	5	6	7	8	9	10
23.	Caffeine (1 pt/cup per day)	0	1	2	3	4	5	6	7	8	9	10
24.	Anxious about life in general	0	1	2	3	4	5	6	7	8	9	10
25.	Insecure/apprehensive about the future	0	1	2	3	4	5	6	7	8	9	10
26.	Sad or depressed (On medication, score 0)	0	1	2	3	4	5	6	7	8	9	10
27.	In wrong job for now	0	1	2	3	4	5	6	7	8	9	10
28.	Under-appreciated at work	0	1	2	3	4	5	6	7	8	9	10
29.	Under-appreciated at home	0	1	2	3	4	5	6	7	8	9	10
30.	Unhappy with family and romantic life	0	1	2	3	4	5	6	7	8	9	10

Score

The score of a normal, fit and healthy human being is less than 20

Higher scores are symptomatic of dysfunction of one or more body systems.

People with high levels of stress usually score well over 100.

For people with a score of more than 80, the ‘background noise’ of their life is becoming louder and louder. It is hard to concentrate on your work when body systems are dysfunctional.

We know a fit and healthy group when we see the majority of scores below 40. This was not the case with this group. By and large higher scores are usually a reflection of

• low levels of fitness

• an inability to deal with what life and work are serving up to them.

Remember, it is not what happens, but how we deal with what happens that determines our level of stress.

This profile is described as poor. The average score was 71. A lot of people are putting up with a lot of background noise. From my assessment this is not a very fit and health group. The risk of absenteeism, presenteeism and workers' compensation claims is considered high.

SCORES ON EACH ITEM, RANKED - the higher the score the worse the problem

60 people completed the profile. We added the scores for each item. The results appear in the table below.

Rank	Symptom		Aggregate score	People scoring 7 or more - high risk -
1	3	Lack of energy	253	12
2	7	Crookback	252	19
3	13	Fitness	235	13
4	11	Overweight	233	13
5	5	Poor sleep	213	8
6	27	Wrong job	184	7
7	24	Anxious	175	7
8	25	Insecure	164	5
9	1	Headaches	158	4
10	26	Depressed	157	6
11	15	Rashes	149	2
12	18	Libido	140	6
13	8	Colds and flu	139	2
14	21	Alcohol	138	3
15	20	Grinding teeth	134	7
16	9	Crook guts	133	2
17	23	Caffeine	132	0
18	6	Snoring	125	8
19	10	Irritable bowel	125	1
20	28	Under appreciated at work	125	9
21	29	Under appreciated at home	98	0
22	30	Unhappy family	96	3
23	16	Mouth ulcers	94	2
24	17	Blood pressure	80	2
25	22	Smoking	70	7
26	4	Candida	79	0
27	12	Asthma	63	1
28	19	Shakes	61	2
29	14	Chest pain	58	2
30	2	Migraines	51	1

We recommend the organisation focus on dealing with the top 7 items, plus the issues of under-appreciation at work and depression.

The smoking scores indicate that the Company has about the community average for smokers. Nevertheless we believe it would be worth assisting the 9 smokers, their friends and family members to give it up.

We believe there is a higher than average number of people who indicated they were depressed. We believe that anti-depressant medication without a sustained physical activity program, nutrient rich diet and counseling is an inadequate form of treatment.

MIND AND BODY PROFILE

How well people score on the Mind and Body profile provides them with a good indication of how fit and healthy they really are.

I read somewhere that we don't see full blown body system dysfunction until the particular system is 70% dysfunctional. What the Mind and Body profile does is pick up the dysfunctions at an early stage - (you know something's wrong and you feel dreadful but you can't put your finger on the particular system that's causing it. It doesn't matter that you don't know the precise system involved. What you are aware of is that one or more of your systems isn't working at full pitch. The good news is that you can restore function to normal by getting fitter, eating wisely, meditating, getting the job you'd love to do ...) Very few people became fitter and healthier in a doctor's surgery!

Being vigorously physically active on a regular and systematic basis is the most powerful symbol of your ability to give back to your Self. On top of that it protects the body from a wide range of dysfunctions and contributes to an enhancement of the body's own recuperative powers.

There is an epidemic of body system dysfunction in our community and it is certainly not caused by a lack of Panadol, Avpro, Diabex, Lipitor, Ventolin, Milantin, Celebrex, Valium, Zoloft, Viagra or Anusol!

The mind/body relationship

The body is an ecosystem of which the mind is an integral part. Major body systems are frequently negatively affected by stress generated in the mind. The body is incapable of dishonesty!

On the other hand, the mind is effected by the healthy working order of other body systems. Certainly it is affected by physical activity, diet, meditation, acupuncture and a low-toxic environment.

People who are physically fit are less likely to become depressed. They are also more likely to have a strong immune system and an autonomic nervous system that is balanced and healthy in its management of key physiological responses. They are healthy and happy. They have normal blood pressure, they sleep like logs, are about their ideal weighty, rarely, if ever get a headache and don't have a crook back.

As your fitness level improves you can be certain that your score on the Mind and Body profile will also.

FITNESS

The fitness profile is comprised of a mix of 10 objective and subjective assessments.

• Are you keeping yourself fit and healthy to the best of your ability?

• What was your score on the mind and body profile?

• Are you about your ideal weight?

• Aerobic fitness test

• Abdominal strength test

• Upper body strength test

• Flexibility test

• Mobility test

• Aerobic activity training behaviour

• Level of energy and vitality.

A reasonable score is over 70%.

Those receiving less than 70 are not training with sufficient vigour or intensity on a regular and systematic basis to keep themselves fit and healthy.


As a group this is a poor profile. Most people confess to not keeping themselves fit and healthy.		As a group, the Mind and Body Profile scores were not good. The profile is a very good indicator of risk of metabolic dysfunction.

Patchy. The people scoring 0 were 20 kilos overweight.		A good score. In the main people are keeping themselves fitter and healthier than they indicated in the first question. This was a good result.

Patchy.		A good result. Only 2 people out of 60 couldn't do 1 situp.

A very pleasing result.		12 people couldn't touch their toes leaving them at risk of musculo-skeletal dysfunction.

A good result.		Patchy.

As a group it's not a bad looking graph. The people scoring less than 50 are not in good shape.

Overall the fitness scores were good.

MUSCULO-SKELETAL RISK FACTOR

Our musculo-skeletal risk factor profile looked at a range of parameters including mobility, strength and flexibility and whether people are training to keep themselves strong and flexible.

The musculo-skeletal risk factor profile is comprised of a mix of 9 objective and 3 subjective assessments.

• Current musculo-skeletal condition

• Age

• Closeness to ideal weight

• Abdominal strength test

• Upper body strength test

• Flexibility

• Functional mobility – the ability to sit down and stand up with ease.

• Shoulder function

• Dominant hand grip

• Non-dominant hand grip

A score of 70% is attainable by those who have a regular and systematic training program.

Those scoring less than 70 are not doing sufficient in the way of strength and flexibility exercises. They are therefore exposing themselves to a high risk of musculo-skeletal dysfunction. (It would be bizarre for a workplace to offer to pay the rehabilitation costs of people who were not keeping themselves strong enough or flexible enough to do their job without succumbing to musculo-skeletal dysfunction, wouldn't it?)

This risk to The Organisation is much higher than the risk we see in other organisations. This is a poor result.


Not a bad result. Those scoring less the 6 need to be obligated attend a prehab/rehab program, for their own benefit and that of the organisation.

The people who scored 6 were about 10Kg over weight. Those to the left of them are even heavier.		A good result. Only 2 people out of 60 couldn't do 1 situp.

A very pleasing result.		12 people couldn't touch their toes leaving them at risk of musculo-skeletal dysfunction.

When you can't get down and up off the floor 7 times in 30 seconds you've got a mobility problem.		This is a pleasing result. In the main shoulder function was good.

Its always the case, few people have a regular and systematic strength and flexibility program. The organisation needs to put in train a regular and systematic training program, on site, that includes 1. specialist prehab and rehab sessions for those at serious risk and those already dysfunctional and on compo 2. daily 'health huddle' stretch and strengthen sessions in the workplace.

Compared with other groups we have surveyed we rate this score as good. There is a strong case of the organisation to implement an obligatory strength and flexibility program for those who scored less than 60 in this profile.

Lack of strength and flexibility is something that The Organisation needs to take seriously and monitor carefully and put in place an organisation-wide strategy to improve musculo-skeletal function. By far and away a high proportion of people do not have a strength and flexibility program. As a result they are getting weaker and tighter by the week, thereby exposing themselves and the organisation to risk.

When push comes to shove and people become dysfunctional, it will be The Organisation that ends up paying the high cost of an avoidable musculo-skeletal complaint. Click here to read the article from injury to dysfunction. Click here to read about swifties and fallacies.

In our opinion musculo-skeletal dysfunction caused by lack of a regular and systematic strength and flexibility program cannot be classified as an injury. Responsibility for musculo-skeletal dysfunction needs to be sheeted home to individual employees, though it’s unlikely to happen without the establishment of a culture within the organisation that supports, values and understands strength and flexibility.

We recommend a range of strength and flexibility classes that are readily available Australia-wide: -

•	Posture and Flexibility
•	Yoga
•	Crookback Clinic
•	Tai Chi
•	Pontius Pilates

The Organisation would place itself in the forefront of OH&S practice if it took the musculo-skeletal risk seriously and moved heaven and earth to educate all staff about this risk and encourage them to take part in a regular strength and flexibility program. Maybe The Organisation and its worker's compensation insurer could invest in a pilot program to increase staff strength and flexibility!

Whilst we rate the score as 'good', the lack of strength and flexibility training and the results of the people who already report being dysfunctional, together with those who scored poorly in abdominal strength, upper body strength and flexibility is a cause for concern and needs the attention of individual staff and managers.

Recommendation

We strongly recommend that the people who are in current poor musculo-skeletal condition, and who lack abdominal strength, upper body strength, flexibility, shoulder function and functional mobility, in particular those who scored less than 60 on the profile, be obligated to attend regular, in-house strength and flexibility classes.

The pressure on the organisation's workers' compensation costs is such that to do otherwise would, in our opinion be to abrogate a responsibility for the prudent management of the organisation's finances.

See the generic list of recommendations.

DIET

The diet profile is designed to assist participants to check out whether they are eating wisely and also one which has appropriate amounts of carbohydrate, protein and fat. It also looks at various eating habits, eg eating too much, eating for comfort ...

• Closeness to ideal weight?

• Do you eat a decent breakfast?

• Do you eat a high fat diet?

• Do you eat a high starch diet?

• Do you eat from the top of the Diet Hourglass?

• How much water do you during each day?

• Do you supplement your diet with essential micro-nutrients – vitamins,

minerals, essential fats (omega 3) and glyco-proteins - and

nutraceuticals - ginko, aloe vera, Echinacea ...?

• Do you eat too much?

• Are you ruled by your addictions to fat, sugar and starch?

• Does the back end of your system work like a charm?

Low scores are usually symptomatic of high fat, high starch, low fibre diets. The results: - people become over fat and constipated.

Australia is in a grip of obesity and body system dysfunction generated by too much of the wrong food on the one hand, and too little of the right food on the other. It is our opinion that diets high in refined, cereal-based carbohydrates and sugar (the garbohydrates) are the reason for this epidemic. Too few people seem to be aware that their level of body fat is affected by the amount of flour and sugar they take in each day. The high starch diet has replaced the high fat diet, with the same consequences.

As a result of the junk food way of life too many people are starving on full stomachs.

One thing that we observed was that not many people are aware that they may be allergic or intolerant of some foods, particularly wheat flour, milk, deadly nightshades, chocolate, alcohol, caffeine, preservatives ...

The great challenge is tackling the inner hunger. You can't satisfy the inner hunger by eating.


The people who scored 6 were about 10Kg over weight. Those to the left of them are even heavier.		Whilst many people indicated they eat a decent breakfast, for most people breakfast is a mix of flour and sugar - breakfast biscuits and toast. The fat police have just about stopped a cooked breakfast out of existence. We're well on the way to eating flour and sugar for tea as well - pasta and ice-cream. No wonder we're becoming fatter and diabetic.

If you're over weight you have to face the issue, do you have a fat guts ...		... or a starch guts?

Patchy.		A good result.

The modern city diet is probably lacking in essential nutrients.		This is probably an accurate reflection of our over-eating habits.

Junk, junk, all is junk.		For most people the back end is working well. For those whom it doesn't work well, try psyllium husk with your breakfast cereal.

Patchy, representing the struggle most people have in staying focused on eating well and getting the balance right between energy intake and energy usage.

Looking at the profile it’s just a bit off the pace and it was reflected in the scores for eating too much flour and sugar.

Most people have a flour and sugar breakfast, attributed to the kelloggification of the Australian diet. You don't eat biscuits for lunch and dinner so why are you eating them for breakfast? The breakfast eating behaviour of Australians is dreadful. Few people have fruit for breakfast. Even fewer have vegetables, or adequate protein and fat.

More and more people are taking vitamin and mineral supplements. I believe there are good reasons to do so. If you don't believe me, I recommend you buy the book, What Your Doctor Doesn't Know About Nutrition May Be Killing You, by Ray Strand, MD.

By their own recognition a small number of people said they over-ate and were ruled by their addictions to junk food.

The operation of the back end of the system was only fair – low scores being reflective of a diet that lacks sufficient fibre.

CHEMICAL INTAKE

The chemical profile focuses principally on the mix of culturally acceptable stimulants and depressants.

• Do you smoke?

• How many alcoholic drinks do you have a week?

• How much caffeine do you drink each day?

• Do you persistently feed a sweet tooth?

• Do you persistently feed a salt tooth?

• How many hours a week do you spend watching TV?

• Do you have a high intake of food additives?

• How do you rate your reliance on headache and pain-killing tablets?

• Are you on sleeping tablets or anti-depressants?

• Are you on diabetes or blood pressure mediation?


What ever you do, don't smoke.		This is a very good result.

Another good score.		Patchy. Sugar - it's everywhere.

A good score.		Turn it off. It's robbing you of your time, your sleep and your vitality.

The march toward more and more inflammatory drugs is on as bones become out of alignment.		Whilst the graph is skewed in the right direction, the incidence of pain-killing drugs continues to increase as the population becomes unfitter.

The increase in reliance on anti-depressant medication is a big worry. It's a key symptom of metabolic dysfunction.		Only two people on blood pressure medication. A good result.

This is a good score.

Depression

A number of people were on anti-depressant medication. The number is rising dramatically within our community.

As the population becomes less physically active, eats diets high in flour and sugar and low in omega 3 fats, selenium and B group vitamins, and live lives devoid of meaning and purpose, we can expect rates of anxiety and depression to increase along with the epidemic in a whole range of body-system dysfunctions.

There is an epidemic of 'depression' in the community, and whilst not wishing to make light of the true ‘black dog’ of clinical depression, for some people the symptoms of stress, unhappiness, sadness, grief, hopelessness, disappointment, despair, vacuity, anger and anxiety are being treated as if they were the symptoms of clinical depression.

I believe it is appropriate for The Organisation to encourage those people with an unhappiness, anxiety or depression problem to make full use of the counselling services of the EAP and encourage them to do the things that unstressed people do - like keeping themselves fit, having a lunch hour outside, taking their holidays, eating wisely, not working too many hours and ‘getting a life’.

It is frequently the case that those people on anti-depressants are not doing the things that unstressed people do to keep their bodies and minds in good shape.

The best book about depression I've read, and what you can do about it, and one that I recommend highly is by psychiatrist, David Servan-Schreiber, Healing Without Freud or Prozac. It reinforces my belief that some doctors are prescribing medication without a proper physical and mental diagnosis. Read the book.

STRESS RISK

Participants completed a simple stress and relaxation profile designed to assist them in making an assessment of how they were affected by stress. It is based on the habits of unstressed people.

If you do what unstressed people do you are less at risk of becoming stressed. I’m yet to see someone who said they were highly stressed or depressed who got a high score on this profile. A good score is over 70.

• How would you rate your current stress level

• Do you get a good night’s sleep?

• Do you take your holidays?

• Are you keeping yourself fit and healthy?

• Is there balance in your life?

• Do you take time off at lunch time?

• How many hours a week do you work?

• Are you good at giving back to your Self?

• Do you meditate?

• Are you happy with your family (and romantic) life?

The matter of stress always needs to be addressed by organisations as part of a personal development thrust, and aimed at all staff. If stress management type programs are to be conducted, all staff need to be involved, otherwise those at most risk and those who are currently most stressed (and too wrapped up in their own busyness) will not attend.

For those who spend long hours at work, I often wonder whether the behaviour is externally or internally driven. I suspect the latter. No body on their death bed ever said 'I wish I'd spent more time at the office.'

A few people are struggling with their family life. This is another fertile area for personal development and counseling programs. It's hard to concentrate at work when your home life is in turmoil

SCORING GUIDELINES

Excellent, scoring 8 or more

Good, scoring 7 or more

Fair, scoring 5 or 6

Poor, scoring less than 5

‘Pass mark’ on all parameters 7/10.


Patchy.		This is not a very good result. A lot of people are not sleeping well.

Patchy. Paul Pearsal in his book Superimmunity' said you need a 21 day away from home holiday every year..		Not particularly good, though the actual result of the aerobic fitness test was good.

Pretty good.		A poor result. Too many people don't take time off to switch off and get outside in the fresh air.

Patchy, though those who work the longest in our society are mothers of young children who have three shifts - one before work, one at work and one after work.		Could be a lot better.

Very few people meditate.		Family life satisfaction is good. But the tail suggests the organisation could move heaven and earth to encourage staff with family problems to go to the employee assistance program for advice and support.

Average score: 56. This is an average score. People could do more to look after their self.

CAREER SATISFACTION

The parameters in the profile relate to a mix of factors influences by the participant, management and their colleagues.

• How close are you to doing the job you’d really like to be doing?

• Are you in the right job for now?

• Is work giving you life or sucking life out of you?

• Are you focused on your career options?

• Do you get good feedback from your manager?

• Do you receive an appropriate financial reward?

• Do you feel you and your work are valued and appreciated?

• Do you work for an organisation that cares about people?

• Do you enjoy the company of the people you work with?

• What’s the level of morale like in your work group?

Normally, when results on the overall career profile are less than 70/100, people agree that they’re not in the right job. Certainly those scoring less than 60 have sufficient issues relating to career management as to seriously consider going somewhere else.