Purpose <p>To explore occupational perspectives of patients with elevated risk of non-return to work (RTW) in cardiac, cancer, and orthopedic rehabilitation. What themes are relevant when patients in medical rehabilitation reflect on their occupational future, and to what extent are identified themes specific to medical specialty?</p> Methods <p>Face-to-face interviews were conducted with 51 patients (63% female, median age 55) of elevated risk of non-RTW in post-acute rehabilitation after hospital stay for an acute cardiac (<i>n</i> = 20), cancer (<i>n</i> = 15), or orthopedic disease (<i>n</i> = 16). Six months after rehabilitation discharge, 41 (80%) participants were interviewed again, to analyze the significance and relevance of the collected themes after return to daily life. The transcripts of audio-recorded interviews were analyzed by a combination of flexible pattern matching and thematic analysis.</p> Results <p>In their occupational reflections, patients considered seven themes related to health (perception of health / health behavior and lifestyle), work (characteristics of professional career/reintegration options/motives for (non) RTW), and personhood (uncertainty about the future/perception of the environment). Disease-specific aspects were found in heart-related anxiety for cardiac patients, perceived uncertainty about the future for cancer patients, and workplace/work characteristics for orthopedic patients. 61% of the participants did not RTW within six months after rehabilitation discharge.</p> Conclusion <p>Occupational reflections of all patients were characterized by the same set of themes, with some themes having more relevance depending on participants’ medical specialty. Perceived uncertainty, health issues and expected barriers led to missing plans for future health-management and RTW-strategies and highlight the need for an occupational planning tool.</p>