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Thank you Anne. What you and Greta say seems reasonable and ethical, though FOM 1993 makes it a little difficult by saying : From Kloss 2006- Page 75- 3.4 The consent of the patient- last paragraph: 'Advice given to management about the results of a medical assessment should generally be confined to advice on ability and limitations of function. Clinical details should be excluded and even when the individual has himself given clinical information to management, the occupational physician should exercise caution before confirming any of it.... .' (FOM Guidance 1993) How do other members of the list read the above statement from FOM 1993. Is this current? Has FOM made a clearer statement like Greta's recommendations? I have a copy of Guidance on ethics for Occupational Physicians( May 2006) and I have not so far found anything similar to Greta's recommendations here yet. Has anyone else? _____ From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of [log in to unmask] Sent: 18 October 2009 16:58 To: [log in to unmask] Subject: Re: [OCC-HEALTH] Employee consent for reports - GMC guidance Interesting point you raise with regard to Greta Thornbory's stance on OH professionals being too precious about confidentiality. I think she was probably referring to occasions when OH advisers consider anything and everything which relates to the client's health status is confidential and cannot be discussed. Over the years that Greta Thornbory and I have worked together we have given joint teaching sessions and presentations on this very issue - our viewpoints are the same. If an employee has already told the manager the diagnosis, or this has been revealed on med certs, then of course this is no longer confidential information. The implications of a condition can be highlighted but clinical details remain confidential between the employee and OH professional. If the employee has told their manager their diagnosis, or they have submitted med certs which include this information then this is no longer confidential their would be no breach including this degree of detail. Greta writes the following in her e-book: Occupational Health 2008 - The business case - special report: "It must be remembered that clinical details remain confidential between the employee and the OH professional and the employer or manager has no right to know the actual diagnosis unless either the employee chooses to tell him or he gives his written consent for the OH professional to make a disclosure. This frequently causes problems and friction between the OH and HR / Management. OH professionals need to consider carefully what they can and cannot say in order to avoid this situation; they can actually explain a lot about a situation or a condition without breaching confidentiality." (Page 75). Anne On 16/10/09 12:55, "Darcy, Paul" <[log in to unmask]> wrote: Dear all, this is a great discussion and is what I feel the list should be about. I'm with Amanda in relation to point 1 (but without the anger though). I expect any of my OHAs to deal with the spectrum of OH referrals/ cases irrespective of complexity. However, where a medical examnination is required, or where there is a statutory or policy requirement for an OHP assessment we still book the employee to see the OHP. I know many other OH departments where anything with a whiff of complexity or a suggestion of potential future litigation goes to an OHP but I really do believe that a competent OHA can deal effectively with many of these cases. In relation to Jane's second point, a couple of years ago at a conference Greta Thornbury made a succinct statement about OH professionals being too precious about confidentiality and that we often used arguments of confidentiality to protect ourselves perhaps to the detriment of the employee. I also find this on occasions when colleagues have requested GP reports to corroborate what an employee has told them rather than this being for the direct benefit of the employee. Times have changed in relation to OH advice being more about functional ability/ capacity i.e. how the condition affects the work rather than things being about a diagnostic label and we can often give excellent advice without breaking medical confidentiality. I also agree that there are times when it is useful for the manager/ HR to know about the specific condition especially if there has been a disclosure on the Med 3 and in these situations often find that the employee has actually disclosed this to their manager. I believe we should be encouraging a dialogue between employees and their managers so that we all don't have to talk in a coded fashion. Keep up the interesting discussions Paul _____ From: [log in to unmask] [mailto:[log in to unmask]] <mailto:[log in to unmask]> On Behalf Of Amanda Savage Sent: 16 October 2009 10:47 To: [log in to unmask] Subject: Re: [OCC-HEALTH] Employee consent for reports - GMC guidance Sorry Jane but I really have to beg to differ here in fact your comments have made me quite angry. Point 1 'OH Doctors (as opposed to nurses/advisers), usually get the more situations to deal with' 'Situations that are fraught with complex considerations are dealt with by the OHP'. This does nothing to progress the 'we are all practitioners in our own right' cause & is most definitely not the situation in my department. We are all practitioners & all deal with any case that comes in regardless of complexity or the possibility of litigation. We may very well discuss cases and advise each other but we moved away from a hierarchical system where the Dr is the lead a few years ago. Point 2 In order for OHA's to break down the barriers within companies and to become part of the fabric, we need to move away from 'medicalising' situations and become more like mediators. Gaining the trust of both employees and employers and moving the situation forward in a win/win way. I know what I am suggesting is quite radical There are some of us who do not have barriers and are already working effectively doing our job (which I hasten to add is medical) with the trust and respect from employee and employer - this is not radical I am sure you will find it is happening in many different areas and take objection to this being seen as 'new ground'. Regards Amanda Savage BSc(Hons);SpPrac OH; RGN; DON; NEBOSH Specialist Practitioner Occupational Health West Midlands Fire service [log in to unmask] <mailto:[log in to unmask]> <mailto:[log in to unmask]> Tel: 0121 380 7441 Mob: 07770863042 P Please protect the environment - think before you print. Unless expressly stated otherwise, the information contained in this e-mail is confidential and is intended only for the named recipients. Any unauthorised disclosure of the information contained in this e-mail is strictly prohibited. If you have received it in error please return it immediatley to me [log in to unmask] and then destroy it. The information contained in this e-mail may be subject to public disclosure under the Freedom of Information Act 2000 unless the information is legally exempt from disclosure -----Original Message----- From: [log in to unmask] [mailto:[log in to unmask]] <mailto:[log in to unmask]> On Behalf Of JANE COOMBS Sent: 16 October 2009 10:27 To: [log in to unmask] Subject: Re: [OCC-HEALTH] Employee consent for reports - GMC guidance I am going to put the cat amongst the pigeons again but really cannot help myself!! So here goes.... Point 1 I know there is guidance from many quarters on confidentiality and the reasons for it but Occ Health it is a slightly different situation than in clinical practice. OH departments serve two masters - both the employee and employer; OH Doctors (as opposed to nurses/advisers), usually get the more situations to deal with - difficult employees can be in conflict with employers, they may be requesting ill health retirement on weak clinical grounds - how can this be dealt with if the employee witholds consent? What about situations where the employee is known to have misled the company by having bogus days off - this is fraud? Many companies now video long term absence cases. Situations that are fraught with complex considerations are dealt with by the OHP. I believe that OH advisers roles are easier to keep to the principles of Access to Medical Reports Act than OH Physicians. In my team we employ the OHP's for the really complex, high profile and 'likely to go to ligitation' cases. This new guidance (and it is only guidance) will certainly affect the service they would be able to provide. Our OHP is on the board of large professional body and has been talking with the GMC about these situations in detail. Currently we are not changing our practice but may be - depends on the outcome of the lobbying. Point 2 Medical details in reports to management/HR are, in my opinion, totally necessary nowadays (sorry Ann). To withhold this information in today's climate of enlightenment and education, I believe, can be seen as obstructive and patronising. There is little point in witholding knowledge that is known by the everyone including the receptionist? What about the diagnosis on the med 3 - how silly do we look if we don't allude to this? Saying that, I would choose what to say, in conjunction with the employee (patient) and with consent, as how best to help their particular situation. We, in Occ Health, should know our organisations and speak their language - so that we can assist both the employee and employer to negotiate a way through a difficult situation. In order for OHA's to break down the barriers within companies and to become part of the fabric, we need to move away from 'medicalising' situations and become more like mediators. Gaining the trust of both employees and employers and moving the situation forward in a win/win way. An (shortened version) example of how this proved beneficial was when a member of my team was dealing with a diabetic who could have hypo's and needed sugar pdq. She wrote (quite correctly) that there was a medical condition which could result in sudden loss of consciousness if the correct treatment was not administered quickly. Management were frightened to death of the consequences - after consent from the employee, the diagnosis and situation was revealed and peace was restored. I know what I am suggesting is quite radical but I believe OH needs to change to meet the challenge of extinction. We cannot afford to marginalise ourselves by taking an unnecessary stance on the subject of confidentiality (lets face, it employees have no idea about our professional code until we go to great lengths to explain it to them) I have seen so many OHA's paint themselves into a corner about this, when a bit of common sense would have sorted it out easily. Now before you all reach for your keyboards - I readily acknowledge that there are situations when confidentiality is utterly crucial, but these are few and far between, I say lets move with the times. I am going now - please be gentle with me.....! Jane Coombs _____ Date: Mon, 12 Oct 2009 22:19:09 +0100 From: [log in to unmask] Subject: Re: [OCC-HEALTH] Employee consent for reports - GMC guidance To: [log in to unmask] The requirements of AMRA apply to a report written by a physician responsible for the care of the employee in conjunction with employment or insurance issues. It does not apply to a report written by a nurse and it could be disputed whether it generally applies to a report written by the OH physician as they are not responsible for the clinical care of the client. Even though AMRA does not apply to reports I have written to Management, I routinely show the report to the client before it is sent. I have nothing to hide and they have the legal right of access to their health records anyway. I question the view that reports written by an OH physician "tend to contain description of clinical detail". Clinical detail included within a response to management is totally inappropriate, no matter who writes that report. Management have no need to know clinical detail. They only need information regarding the implications of the client's clinical condition in relation to workplace issues; clinical detail is unnecessary. Anne On 7/10/09 17:31, "N. Rostami" <[log in to unmask]> wrote: Kim, AMRA (1988 )does not apply to nurse's report as their reports should not contain any clinical details and must only deal with the impact of the UMC on the functional capacity of the subject and thus the advice for adjustments. Refer to this document: page 9 , paragraph 3): Holland-Elliot K, Harrison J, East J, Leeser J, Graham-Cumming A, Skidmore A, and Batty L (2007), Guidance for Occupational Physicians on Compliance with the Access to Medical Reports Act, www.facoccmed.ac.uk/library/docs/atmra_may08.pdf <http://www.facoccmed.ac.uk/library/docs/atmra_may08.pdf> <http://www.facoccmed.ac.uk/library/docs/atmra_may08.pdf> Bearing in mind that the OP reports tend to contain some description of the clinical details when for instance justifying a case for IHR, I think that it is good practice to comply with this Act at all times. I am aware that this can cause a lot of logistical issues in terms of the delay in the release of the OH report to the referrer until it is seen by the subject. As per the Act (and when obtaining a GP report)the subject has a choice to peruse the report prior to its release to the employer. The implication for the employer is that they have to arrange to obtain the employee's written consent. We know that all written correspondence with an employee on long term absence are subject to delay and difficulties. However, in complying with this Act the employer has to discuss fully the reason for the referral to OH with the employee before getting their written consent, rather than just refer the employee to OH without their prior knowledge and the understanding of the reasons. Perhaps, this will be a good reason for why the OH work for the functional assessment/ reasonable adjustments (with no reference to clinical details) will have to be carried out by an OHA for efficacy of time! Whereas all complex cases and IHR cases will naturally be allocated to OP as the timescale for the receipt of the report may not necessary affect the absence length. This said, it is good practice for the OHA to ask the subject if they would prefer to see the report before it is sent to the manager. It is possible to even read out the report to the subject over the phone to ensure that there are no inconsistencies, nor errors in the e.g. dates of the future interventions and such. _____ From: [log in to unmask] [mailto:[log in to unmask]] <mailto:[log in to unmask]> <mailto:[log in to unmask]> <mailto:[log in to unmask]> On Behalf Of Kim Scaysbrook Sent: 07 October 2009 12:06 To: [log in to unmask] Subject: [OCC-HEALTH] Employee consent for reports - GMC guidance One of our OP's came in today and has been to a seminar on consent. As I understand what he was saying - the GMC have now interpreted OP role as providing care to individuals (even through they don't prescribe etc) and therefore all reports should have employee consent to release before they go to manager/HR etc on a similar basis to that used under AMRA ie they have the right to see the report and withdraw consent for it's release. He is going to discuss this with the other OP's and the Nurse Manager on Friday. Alan - have you heard anything about this? At present, it doesn't seem to have filtered to the NMC for the OH Nurses but I imagine that their will be implications for us as well. Your thought's appreciated Kim ******************************** Please remove this footer before replying. 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