The Role of the Occupational Physician - Assignment Example

Running head: Discuss the Role of the Occupational Physician in Implementing The COSHH Regulations Since the introduction of the Health and Safetyat Work Act (HASAWA) in 1974 there has been increasing legislation on health and safety. Landmark regulations stemming from this which have had an impact on many industries are the Control of Substances Hazardous to Health (COSHH) Regulations 1988, the Noise at Work Regulations 1990 and the ‘six pack’ of regulations emanating from the European Community Framework Directive: 1. Management of Health and Safety at Work Regulations 2. Work Equipment Regulations 3. Manual Handling of Loads Regulations 4. Workplace Health, Safety and Welfare Regulations 5. Personal Protective Equipment at Work Regulations 6. Display Screen Equipment Work Regulations. The Health and Safety at Work etc. Act 1974 imposes a general duty on employers to take reasonable care to protect their employees from risk of foreseeable injury, disease, or death at work. The Control of Substances Hazardous to Health Regulations 1988 (COSHH Regulations) extend and clarify the duty of employers under the 1974 Act in relation to hazardous substances in the workplace and impose duties to monitor health risks, workplace hazards and health of employees. In this respect occupational health physicians possess a leading role in enforcing the Health and Safety Executive or the local authority, depending on the type of activity. (Boyle, 1994, p. 10) The COSHH Regulations have been perhaps the most significant in the development of occupational health and safety measures. A CBI survey in 1993, which showed that 50 per cent of private sector employers had only introduced such measures over the last five years, seems to reflect this trend. To many employers the implementation of safety regulations has been seen as, and indeed is, a burden on both staff and financial resources. Although alterations in work methods, practices, equipment and environment may prove costly, probably the greatest problem has been assessment. These regulations all require an assessment to be made of the risk by a competent person. In organisations which do not have trained safety or occupational health staff it has been difficult to set up suitable assessment programmes. Alternatives have been to: 1. Appoint a trained safety officer; 2. Appoint a trained occupational health practitioner; 3. Employ health and safety practitioners on a consultancy basis; 4. Train designated staff. The concept of risk seems difficult for many managers to grasp. It is simply the likelihood of a known hazard causing damage to health. Another dimension to this assessment is the numbers of staff, contractors and the public who may be at risk. The Management of Health and Safety at Work (MHSW) Regulations have closed any gap that might have been supposed to exist in the list of hazards, which have to be assessed. Although the HASAWA did require protection of staff, assessment of risk was tied to specific regulations. The MHSW Regulations require the assessment of risk for all workplace hazards. Of course, those organisations, which are complying with previous industry and hazard specific regulations, will find that they have already covered most areas. Those, which are, not will have to set in train the full assessment programme. It is certainly not possible to address this issue without the use of trained health and safety experts. Occupational health physicians should not be expected to control sickness absence but they are able to assist managers in implementation of the rules on their local workers. The physician should look at the epidemiology of sickness absence, providing statistics on levels of absence in different work groups. This may help to pinpoint not only hazards but also management weaknesses and low morale. It is not always possible to give a realistic prognosis for an individual’s attendance at work, but some indication of what can be expected in relation to a particular diagnosis is possible and may assist managers in formulating reasonable attendance standards. With the new arrangements for Statutory Sick Pay it has become increasingly important for health physicians along with managers to deal with sickness absence in a cost-effective way. (Dorsey, 2003, p. 44) Rehabilitation and Resettlement Occupational health professionals have a particularly important role to play in this function. They are the only people with knowledge and understanding of the medical condition and the requirements of the job. General practitioners are at the mercy of their patients whose description of their jobs may directly relate to their eagerness or reluctance to return to work. Unfortunately, most organisations now seem unable to accommodate the walking wounded for any length of time, making rehabilitation jobs or variations of jobs difficult to organise. Similarly, no one wants to take on from another department someone who appears to have a long-term health problem. This all leads to the unnecessary loss of trained staff and longer-term sickness absence. Occupational health practitioners continually strive to encourage management to be more flexible in this respect. Implementation of Health and Safety Legislation Where an organisation has a qualified safety officer it would be normal for him to work closely with the occupational health professional, providing management with guidance on the implementation of policies designed to meet the requirements of health and safety legislation. The roles of both professionals are complementary. Where there is no professional safety officer, the occupational health incumbent will provide management with advice, help to develop policies and training programmes, assist in assessments, provide training and undertake any necessary medical surveillance or biological monitoring. For small employers this combination of roles may be the most economical approach. Accident Review It is normal for accident reports to be copied to the occupational health department. Under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1985 (RIDDOR) the occupational health physician is required to report any industrial disease. The occupational health department expects to follow up any accidents to see that appropriate action has been taken and advise on this. It often falls to the department to provide accident statistics and suggest target areas for safety campaigns. Treatment Occupational health is not a substitute for general practitioner delivery of primary care. Fortunately, this is now recognised by both general and occupational health practitioners so there is no misunderstanding between the two professional bodies. Of course, it would be unreasonable for the occupational health professional not to offer advice to those injured or becoming ill at work. In some instances timely intervention may prevent sickness absence and, at the very least, provide individuals with some relief until they can see their general practitioner. Where there is a regular occupational health presence, the general practitioner may request help with routine treatments, making this easier for the patient and reducing the need to take time off. Increasingly, other health professionals are being introduced into the workplace to enable employees to obtain treatments conveniently and often at reduced rates. Osteopaths, therapeutic masseurs, Alexander technique practitioners and many others are now part of the occupational health portfolio. The use of certain substances (e.g. asthmagens) carries a strict requirement to conduct health surveillance. Managers are, therefore, required to liaise with the College Health & Safety Adviser and its Occupational Health Physician will undertake such health surveillance as is identified to be necessary. The post holder will retain such health records as are required to be kept. Staff must be provided with the results of any monitoring of exposure that takes place, and the collective results of health surveillance undertaken. (Policy1a, 2006) Although occupational disease (i.e. specific disease resulting from exposure to a hazard in the workplace) is becoming less frequent, there is still a need for vigilance where chemicals and new technology are in use. Occupational health physician has a major role in detecting, through surveillance, attendance records and other forms of recording, the incidence of work-related disease. The most recent epidemic of work-related upper limb disorder has been highlighted by occupational health practitioners and they are spearheading its control. Confidentiality Occupational health requirements vary widely from industry to industry but the basic concepts and ethics remain the same. It should be remembered that occupational health physicians and nurses are bound by strict rules of confidentiality in relation to individual members of staff. ‘The status of an occupational physician in an organisation must be that of impartial professional adviser, concerned primarily with safeguarding and improving the health of employed persons’ (Faculty of Occupational Medicine). Occupational health staff is restricted from discussing the clinical history of the patient with a manager unless specifically requested to do so by the patient. For the same reason, medical records are the property of the occupational health department and no other staff may have access to them. Reported information on the patient should not contain details of their medical condition but only information about how that condition affects their ability to work. Managers sometimes find it difficult to accept these principles of medical confidentiality and may take time to understand and feel secure about the occupational health role. Occupational health staff will consider any situation from both the organisation’s and the patient’s point of view and should not put either at risk. Managing Sickness Absence Sickness absence, or absence attributed to sickness, is a major and increasing cost to organisations, which can only effectively be dealt with the help of occupational physician. A recent survey by the CBI estimated that over 160 million working days are lost through sickness each year. The physician helps in overcoming the absence in various methods of controlling absence, including sick pay schemes, the use of sickness absence statistics and recruitment checks. An attempt is made to clarify the role of occupational medicine in the management of absence. Early Retirement on the grounds of Ill Health There is considerable variation in the hurdles, which a sick employee has to surmount to be eligible for this type of dismissal. Entitlement related to length of service also varies considerably. Some super annuation schemes readily accept cases where the disability is peculiar to the requirement of the particular job, whereas others accept a more general disability. Incapacity continuing into the foreseeable future or permanent incapacity is essential. Role in Occupational Health The role of occupational health in controlling sickness absence is often not understood by management. Occupational health physicians do not control or monitor sickness absence. This is the responsibility of the line manager. What occupational health should do is provide management with information on the existence of any underlying medical conditions, on the likely length of absence, on the likely frequency of absence, on the probable need for short-term modified work or long-term redeployment, and in general terms the likely effect of the medical condition on fitness for work. Intermittent Persistent Absence These cases are usually much more difficult to define and manage. If, as is usual, the reasons for absence are all minor, unconnected ailments, there is no legal requirement to obtain medical advice. However, this sort of absence may mask an underlying significant health problem or work-related disorder. It is therefore sensible for the manager to seek medical advice. This is more readily available where there is an occupational health service. In such cases the employer needs to consider: 1. The nature of the illness; 2. The likelihood of this illness recurring or of some other illness; 3. The length of the various absences and the spaces of good health and performance in between; 4. The need for the work to be done; 5. The impact of the absences on other employees; 6. The extent to which the employee has been made aware of acceptable standards. The employee may indicate that there is an underlying health problem. No useful purpose may be served by obtaining medical evidence except in these cases, as there is no underlying medical condition, and it is impossible to verify the situation after the employee has returned to work. Sickness absence statistics are particularly useful in managing cases of frequent absence because they provide management with acceptable standards of attendance. Employees should be interviewed and made aware of these standards. (Potter, 1997, p. 78) They should be warned that, if they do not meet these standards, dismissal may result. They should then be given a date when their record will be reviewed. During this period it is important to maintain proper attendance records. If at the end of the review period there has been no substantial improvement, the employer is entitled to dismiss the employee. This dismissal will not be on medical grounds but on the grounds of unacceptable attendance. Of course, the situation is rarely so clear cut; employees often achieve a better record during the monitoring period but subsequently revert to the previous high level of absence. Where, on interview, the employee indicates that there is an underlying health problem, medical information should be obtained as in cases of long-term absence. Consideration should be given to: 1. The relationship of the underlying health problem to the absences; 2. The likely resolution of the underlying problem; 3. The prospects of normal attendance; 4. The appropriateness of early retirement on medical grounds. Medical Advice In order to come to a reasonable decision, it is obviously necessary for the employer to obtain medical information. This may be obtained from the occupational health physician, the individual’s general practitioner or specialist, or an independent specialist. Where the doctor approached is responsible for the care of the employee, the provisions of the Access to Medical Reports Act 1988 apply. In practice this means that the employee must consent in writing to the report being requested, having been informed of his rights. He must be given the opportunity to see and agree the report and he has the right to request amendments. If the attending doctor does not agree to the amendments, the employee has the right to attach a personal statement. When a report is requested the doctor should be told in writing the reason for the request and any possible outcomes. In the case of long-term absence it is usually essential to obtain information from the attending doctor. Where there is an occupational health unit, this information should be obtained through the unit, thus ensuring a fuller report while preserving medical confidentiality. Unfortunately, not all doctors are prepared to co-operate with employers in this respect and difficulty in obtaining their reports may result in considerable delay in resolving the case. It is sensible to state any fee offered for the report at the time it is requested to avoid embarrassingly large bills. The British Medical Association recommends a standard fee for such reports and the employer should not expect to pay more than this. Fortunately, many primary care doctors do not seek a fee. If the data collected facts lacks strict statistical validity, but a number of services sampled over a cross-section of industry gave considered replies, physician should focus upon the background causes of disease or sickness of the worker. Suppose the data confirms that a great many people are diagnosed as suffering from musculo-skeletal problems. The number of cases seen on a weekly basis suggests a scale of problem beyond available resources adequately to follow-up and identify reliably any occupational or leisure basis for the complaints. In this case to achieve accurate diagnosis, clinical examination of the patient and follow-up inspection and assessment of the job and workplace seems desirable in all cases, which would impose a very heavy load on the occupational physician or other specialist colleagues. The impression was confirmed that so-called psycho-social factors are having an impact on musculoskeletal problems, and that high among these are problems at work and the fear of unemployment, as well as difficulties with marriage and childen. More surprisingly, economic and housing seemed less important, but the influence of a combination of all these factors is recognised by many of the respondents. (Hanson, 1998, p. 44) The occupational physician regularly finds that individuals with frequent sickness absences are using these to cover unresolvable domestic pressures. General practitioners will often certificate such absences with a diagnosis such as ‘anxiety state’. In these circumstances this is not far from the truth. The occupational health physician must judge whether the underlying situation will soon be under control, and the likelihood of future satisfactory attendance. Managers may be uncomfortable with this resolution of the problem, but some flexibility can often result in the return to full attendance and competence of a valued employee. Managed Care Managed care has also influenced the stress experienced by physicians, particularly in the areas of control over work and collegial and patient relationships. A key characteristic of the managed care era is that third-party payers exert influence over clinical decision-making and healthcare delivery. Physicians report that interference by non-physicians such as insurers was a source of stress that led to feelings of decreased professional autonomy and, ultimately, reduced job satisfaction. As one physician notes, “managed care companies acknowledge they push for the least intensive setting possible for care and that multiyear outpatient (mental health) therapy is generally insurance history” (Levick, 1998, p. A1). In research examining the relationship between managed care, communication problems, and physician satisfaction, Lammers and Duggan (2002) found that for some doctors, contact with managed care organizations was a factor in predicting communication problems that led to lower satisfaction. In addition, a number of physicians also reported worrying about the stress-related aspects of their jobs created by managed care (e.g., more workload, rising patient volume, etc.) and the effects of these stressors on their relationships with colleagues and patients. In a similar study, doctors reported dissatisfaction with how managed care has intensified demands on their productivity, cost-containment, and case mix. In another study, doctors believed that managed care has contributed to their job stress by placing more pressure on duties such as charting, completing paperwork, and complying with constantly changing regulations. Role stress related to interpersonal relationships is another common source of stress for healthcare professionals. Still, many organizational aspects of managed care significantly affects caregivers on an interpersonal level, particularly those who work directly at the patient’s bedside. References Boyle A.E, (1994) Environmental Regulation and Economic Growth: Clarendon Press: Oxford. Dorsey M. Alicia, (2003) Handbook of Health Communication: Lawrence Erlbaum Associates: Mahwah, NJ. Fingret Ann & Smith Alan, (1995) Occupational Health: A Practical Guide for Managers: Routledge: New York. Hanson M. A., (1998) Contemporary Ergonomics 1998: Proceedings of the Annual Conference of the Ergonomics Society, Royal Agricultural College, Cirencester, 1-3 April 1998: Ergonomics Society: London. Lammers, J. C., & Duggan, A. (2002). Communication predictors of physician’s satisfaction with managed care. Health Communication, 14, 493–514. Levick, D. (November 8, 1998). When slashed writes are not enough: Insurers tighten access to mental healthcare. The Hartford Courant, p. A1. Potter Dave, (1997) Risk and Safety in Play: The Law and Practice for Adventure Playgrounds: E & FN Spon: London. Policy1a2006 accessed from Read More