Effective Interaction

One best practice for safety professionals is to have a working relationship with both the local occupational clinic(s) and the closest hospital.

WORKER'S compensation fraud is difficult to pull off without factoring in the decisions made by a medical provider. However, safety professionals can have a huge impact on helping medical providers make informed decisions. As safety professionals, are we doing all we can to make sure the medical providers know who we are, what we do, and how we feel about our employees?

In the early 1700s, Dr. Bernardino Ramazzini (1633-1717) published the book "De Morbis Artificum," and occupational medicine began in earnest. It was Ramazzini, the father of occupational medicine, who first advised his colleagues to "ask what the patient does at work." But from the perspective of the 21st century HSE professional, it is unfortunate Dr. Ramazzini did not also advise his colleagues to then initiate an open-minded communication partnership with the employer.

The Busy 'Safety Day'
When a work-related injury or illness occurs, the most time-consuming duty of the safety professional's day can be responding to it. It begins with the immediate provision of care, site containment, cleanup, and witness reporting, then there is the implementation-assignment closure of action items related to the investigation. Whew! In addition, throughout all of this, progress of the worker's comp case has to be scrutinized in order to remain a profit center for the company.

For states whose worker's compensation statutes do not allow the employer to give medical provider directives, employer partnership in that care becomes a race. Can the safety professional get to the medical provider in time? When he or she does, the winner is always the employee--along with the fan in the stands, the employer.

Laying the Groundwork
One best practice is to have a working relationship with both the local occupational clinic(s) and the closest hospital. A required post-injury/illness drug test can quickly draw the employee to one of those sites. For the sake of convenience, the employee probably will stay there to receive care.

In this situation, the clinic or hospital staff is already aware of the employer's aggressive return-to-work provisions, written or video-recorded job descriptions, and most importantly, its safety culture. The effect can be nearly ideal: immediate communication as to diagnosis and recommended care, an understanding the role of the safety professional, and the knowledge of where to turn if the employee's report is suspicious.

On the other hand, the employee's personal physician can be more of a challenge. Unfortunately, I have often found they prefer to err on the conservative side and write arbitrary days off and restrictions as though their patient works for an 1890s robber baron; they do not even factor our profession into the equation. These are the medical providers who ask questions such as:

  • "Do you need some time off?"
  • "What machines should I list for you to stay away from?"
  • "How soon do you think you can get back to work?"
  • "What is the name of the product that you think is bothering you?" (This is not followed by a request for the MSDS.)
  • Or, they make statements such as:
  • "You work in a factory? It must be work-related."
  • "I hear from you that other employees are experiencing the same symptoms. That's all I need to know."

When their only information comes from the company's walking wounded, some of whom have secondary gain agendas, I can understand this. We need to be proactive.

One solution is a fax form with a quick message and a hope that it finds its way into the employee/patient file. Here's a summary:

"Howdy, I'm here. Thank you for taking care of our employee. What questions might you have before you determine work-relatedness? We have a very aggressive return-to-work policy. Would you like a picture of the injury/illness site? S/he works the 1st/2nd/3rd 10-hour/12-hour shift. We'll creatively accommodate any restrictions, including partial hours. We need restriction details so there can be no guesswork for job assignments. Attached is our Temporary Alternative Duty form. Please do not count weekends or off-shift days as time off unless it is required. Here's all the information necessary to contact me."

A second way to get this information into the medical provider's hands is to have an envelope with the above information made up and ready to hand to the injured/ill employee right after he or she makes a report. Naturally, severe cases and unreported cases aren't covered, and there's no guarantee this transfer of information actually will happen. But when it can, the message to the employee is that there are three of us working toward his betterment. The partnership has begun.

The Importance of Dialogue
Another solution is to strive to turn our employees into safety ambassadors--giving them as much accurate worker's comp information as possible and empowering them to feel in control of their own safety. (If we are still of the old school that feels "What they don't know can't hurt us," we'll never pull this off.)

But there is another side that would seem to be entirely out of the safety professional's control. These are the medical providers who are not willing to effectively partner with the employer and, from an outside view, do not even effectively perform their role as a patient advocate.

A non-office worker was given "office work only" restriction for a musculoskeletal disorder. It took four attempts to get the medical provider to clarify what was meant by this restriction. When we finally received definitive pounds to lift/repetitions per hour/reaching degrees, etc., we were able to assign a temporary production (factory floor) workstation that was well within them. The next day, after a call from the employee to the medical provider, we were again faced with an updated form that again stated "office work only."

Another employee was diagnosed with a different musculoskeletal disorder. After being discharged from care, the employee is back doing the same job and similar strain symptoms appear. The medical provider decided to return him to work with permanent restrictions of the maximum lift set at 10 pounds. The company provided work within the restrictions.

This is discussed with the employee. Prospective jobs that are within the restrictions were reviewed so everyone was in agreement about future assignments. The question of advancement comes up. The honest answer given was that this restriction could be a block in some areas, but not in others. The meeting concludes.

The next day, the employee came back to work with a different "return-to-work" form from the same doctor. This time, there were absolutely no restrictions!

Upon communication with the medical provider, he shared that the employee insisted on new restrictions and stated he would "take the risk" of future problems. We checked with our attorney and were told we should follow the new form and not do anything different with this employee, as far as work assignments. The company dares not terminate an employee who is willing to take such risks.

There is a recourse for this. If an occupational clinic relationship has been set up, it can send in the cavalry and perform a "fitness for duty." The company also can resort to an Independent Medical Evaluation. These will, of course, add time and expense to the case, and usually they translate into an unhappy employee who chooses to follow her own doctor's advice while the employer stands against both of them with another doctor. From the employee's perspective, neither the company nor the new doctor really cares for her.

Dialogue is needed between the medical professions and the safety profession. For each individual case, the earlier the better. Awareness of the employer's consideration for a patient is gained by the first communication. Sharing pictures or videos of workstations removes misconceptions. Credibility for the safety professional can be earned and increased, as the employee gradually becomes the liaison in the new partnership. If the liaison role is ignored or abused, the groundwork is set to continue the partnership without it.

In this arena, misunderstandings can be addressed early and without confrontational perceptions. In the worst case, if the medical provider is not open to the offers, at least there is documentation that we did try. In the best case, upon patient discharge, a "thank you" can be sent for a successful resolution.

The good news in all of this is that every time an HSE professional takes both time and courtesy to make a convert out of a previously uninformed medical provider, it paves the way for the rest of us.

This article appeared in the Product Literature supplement to the February 2005 issue of Occupational Health & Safety.

This article originally appeared in the February 2005 issue of Occupational Health & Safety.

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