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
Tel: 0121 380 7441
Mob: 07770863042
P Please protect the environment - think before you print.
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-----Original
Message-----
From:
[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>
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]]
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
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