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Family physicians' experiences with workplace injuries

At a glance:
Doctors see themselves as having an important role in helping a patient to recover from a workplace injury. While willing to cooperate with employers, insurers and other health care professionals, they are cautious in these dealings. Doctors worry about patient confidentiality and about protecting their independence as treaters. They have found that patients', employers' and insurers' needs often conflict and are difficult to balance.

Communicating with employers may be easier for doctors if the compensation system was organised to minimise these worries.
Perspectives:
Employee
Managing work injuries is a difficult area for treating practitioners. Doctors are used to dealing one-on-one with the patient. In the management of work injuries many other people are involved. The doctor's primary concern is you as the patient. The doctor may be unsure about communicating with other parties, particularly if you are not present at the time.

It is important that treating practitioners be involved in discussing a return to work. The system needs advice from the treater about your abilities and capacities. This is often best done when you are with your treating practitioner. It is preferable for the discussion to occur with everyone together, then concerns about confidentiality and problems with communication will be less.
Employer
Treating practitioners find return to work management difficult. The treating practitioners' commitment is to the patient, and the requests of the system can be at odds with the normal doctor-patient relationship.

Many of these issues can be addressed by getting everyone together for a discussion. If you can be available at the time of a consultation to talk with the doctor and the patient some of the doctors concerns may lessen.

Discussions about a person's capacities, abilities and suitable duties are not confidential matters. If you can present a positive path forward, one that it is clearly about supporting the individual back to work and matches the treating doctor's restrictions, or you can suggest possibilities for the future if the person is totally off work, then a working partnership with the treating practitioner
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 is more likely to be successful.

Attempting to get information about the person's specific diagnosis, what other factors might be influencing the situation, or personal information, is likely to get the treating practitioner offside.
Treater
Discussion about return to work is not a confidential matter. Discussing a person's restrictions and whether they can perform certain tasks is part of the open process. This information is written on certificates.

Strategies that other doctors have suggested include:

1. Requesting the employer be available at the time of the consultation and then discussing a return to work with the patient, while the employer participates via a speakerphone.

2. Inviting the employer to the consultation rooms and meeting them with the patient, after the patient has been seen individually.

3. Visiting the workplace to understand the environment can be a valuable experience for a treating practitioner's insight. It can also give the patient a high level of confidence in the doctor's capacity to understand the issues and appropriate management of a return to work.

4. Being clear about the importance of a return to work to the individual's medium to long-term health, explaining the health benefits of work to the person, and ensuring that the patient gives informed consent about any discussions regarding the return to work.
Insurer
It is well-known that treating practitioners find managing work injuries difficult. As this study suggests the difficulties lie in issues of communication and confidentiality.

Discussions with treating practitioners will be enhanced by clearly focusing on matters that are directly related to return to work issues, by ensuring the patient is present at the time of the discussion, and by working with the doctor in a way that is clearly focused on supporting the patient.
Original Article, Authors & Publication Details:
G. Russell1, J. B. Brown2 and M. Stewart2 (2005).

Managing injured workers: Family physicians' experiences. Canadian Family Physician; 51:78-79

1Centre for Studies in Family Medicine at the University of Western Ontario (UWO) in London.

2Centre for Studies in Family Medicine at the Thames Valley Family Practice Research Unit at UWO, London.
Background, Study Objectives, How It Was Done:
This study looked at family physicians' experiences in managing workplace-related injuries. Family doctors are largely responsible for the care of people who are injured at work. Workers' compensation authorities have tried to improve care of workplace injuries in family practice, as effective early treatment can speed recovery and return to work after injury. However, views on the effectiveness of family practice in treating workplace injuries vary.

Family doctors in Ontario (Canada) were interviewed. The doctors involved varied in experience, type of practice and familiarity with workplace injury. 13 physicians were approached by a letter, then a phone call 1 week later.

The doctors participating in the study (10) were interviewed face-to-face in their offices, between February and May 2001. Interviews lasted between 45 and 60 minutes. 7 men and three women were interviewed, with 1-30 years' experience in practice. Two worked in rural areas and two in academic teaching centres. Two had had experience in occupational health outside of their general practice.
Study Findings:
Managing injured workers:

Doctors reported that for most workplace injuries, treatment and recovery were straightforward. Difficulties came from injuries that were caused by repetitive strain,
strain
Injury to a muscle in which the muscle fibres tear or become irritated as a result of overstretching or wrenching
 or where the cause was unclear. In general, physicians' diagnosis
diagnosis
The process of identifying a medical condition or disease by its symptoms, the findings from a medical examination, and from the results of various diagnostic procedures.
 and management of workplace conditions was in keeping with accepted guidelines. However, though X-rays are considered unnecessary unless a serious problem is indicated, X-rays were routinely done due to the expectations of the patient, or other health care professionals.

Few physicians evaluated the patients' workplace in detail. Doctors thought that a patient's attitude to recovery was an important factor in their treatment, and that a good attitude could be encouraged. Doctors expressed frustration with cases that did not improve with treatment.

Working with employers:

The doctors in this study agreed that other parties in the workers compensation system, including employers, could influence a patient's recovery. While some doctors enjoyed working with employers towards a patient's recovery, most worried about confidentiality issues and didn't communicate much with employers. Patients rarely asked their doctors to contact their workplace. Some doctors said they didn't have time to contact employers, or didn't see it as part of their job.

Working with other health professionals:

Doctors saw an advantage in communicating with other medical professionals in the workers' compensation system, but they worried about a conflict of interest, especially if the medical professional was working with the patient's company. Nurse case managers from the Workplace Safety and Insurance Board contact physicians in difficult cases. The doctors who participated in this study did not find the case managers helpful, but rather thought they further complicated the return to work process and could undermine a patient's confidence in their treatment. Most doctors believed that the insurer didn't understand how to work well with family doctors.

Family physicians' role:

The doctors in this study thought that family physicians play an important role in the care of workplace injury. They felt that they were most responsible to the patient, rather than the employer, or insurer. Doctors varied in their willingness to speak on behalf of the patient to their workplace or insurer, but wanted to keep good relations with the patient as they had to carry on that relationship in the future.
Conclusions:
The doctors who participated in this study thought they had an important role in helping a patient to recover from workplace injury. They found that patients', employers' and insurers' needs often conflicted and were difficult to balance.

While willing to cooperate with employers, insurers and other health care professionals, doctors were cautious in these dealings, worrying about patient confidentiality and protecting their independence as a treater.

Doctors were committed to their patients, and found this commitment could interfere with their interaction with other parties in the workers' compensation system.

To encourage better treatment for work-related injury there needs to be better communication and cooperation between doctors and other members of the workers' compensation system, while giving consideration to the doctor-patient relationship.
References:
PubMed Abstract
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