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Competency 4 – Maintaining relationship with patients:Understand the different roles, of relevant parties

Objective: to ensure the appreciation of the professional position of the OH advisor, employer and employees

KNOWLEDGE

UNDERSTAND THE DIFFERENT ROLES, OF RELEVANT PARTIES AND INTERACTION BETWEEN OH ADVISERS, TREATING DOCTORS, PATIENTS AND THEIR EMPLOYERS

The occupational health doctor, to be able to perform their job effectively must collaborate and communicate with a number of different professionals across varying agencies. Therefore it is important to understand the role of each of the agencies they might encounter in their practice.

This can be looked at in detail by considering each party’s role:

Occupational Health Advisors (OHA)

Occupational health advice can be given by health professionals and non health professionals. Health professionals include an occupational health nurse (OHN) or occupational health doctor (OHD). The term OHA is usually applied to the services provided by an occupational health nurse. Occupational health professionals provide an independent professional opinion regarding matters related to health and work. They have responsibilities to the employee, employer, working colleagues and the greater public. Occupational health doctors working practices are governed by the General Medical Council (GMC) and nurses by the Royal College of Nursing (RCN); both must put the interest of the employee first. Consultations with employees are bound by confidentiality. Occupational health professionals are able to divulge information to employers in pre employment medicals related to working ability i.e. fit for role, not fit, but without divulging clinical information. (Guidance on Ethics for Occupational Physicians)

Treating Doctors

This role can be undertaken by any hospital or primary care doctor who is responsible for the clinical care of a patient. Their primary responsibility is to the patient. Working practices are governed by the General Medical Council (GMC), and all consultations are confidential. Any information relating to such patient must only be divulged to third parties with informed consent or a court order.

Patients

Individuals who are seen by treating doctors are termed patients, whilst the same individuals seen by the OHP/OHN are usually termed employees, clients or customers.

Employers

Have a responsibility to ensure that their employees are working in a safe and healthy environment. This needs to be balanced with ensuring that the workforce is being managed efficiently and fairly. Occupational health advice is financed by employers to provide an independent professional service. However, there can be a misconception amongst some employers that the role of an OHP/OHN is to prioritise the needs of the employer first. Misunderstanding of the ethical framework by which occupational health providers operate can also occur. Such confusion can be avoided by clear discussion on the role of occupational health and ethics in advance. This can include how the treating physician’s responsibilities are different to that of an OHP/OHN and the fact that clinical details relating to employees should not be given to a member of management without the employee’s informed consent.

There are situations in which an OHP/OHN may need to contact a treating doctor regarding an employee. This may be for obtaining further medical information to assess an employee’s fitness for work or informing treating clinicians about a proposed rehabilitation programme or findings on health surveillance. In either situation consent of the employee is required before contacting the treating doctor. In the first situation (to obtain a medical report) consent under Access to Medical Report Act 1988 applies (see Good clinical care: communication – principles of consent). 

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