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Competency 4 – Maintaining relationship with patients:Understand the relationship between the occupational health doctor and the patient

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

KNOWLEDGE

UNDERSTAND THE RELATIONSHIP BETWEEN THE OCCUPATIONAL HEALTH DOCTOR AND THE PATIENT.

1.   Good Occupational Medical Practice 2010 (Faculty of Occupational Medicine).

2.   Ethics Guidance for Occupational Health Practice 2012 (Faculty of Occupational Medicine).

Occupational health doctors like any registered medical practitioner, have an ethical responsibility to put the interests of the patients first. Thus, an occupational health doctor, learning of a health risk to a worker, has a responsibility to protect the health of the employee even if this is to the detriment of the employer.

However the usual therapeutic relationship between a doctor and patient does not always apply in the context of an occupational health setting. The occupational health doctor may be acting or be perceived to be acting on behalf of a third party, for instance the employer. This can lead to conflict where the patient might be reticent to disclose relevant personal information. It may also lead to conflict where an employer, employing the occupational health physician does not fully understand the professional duties of the doctor which is to protect information about their patients or others who consult them in a professional capacity. The absence of the usual therapeutic relationship between patient and doctor does not exempt the doctor from his/her professional duties imposed on all members of the profession.

These duties include:

  1. Treating information about patients as confidential
  2. Being satisfied, before providing treatment or investigating a patient’s condition that the patient has understood what is being proposed and why, and informing the patient of any significant risks or side effects associated with the treatment or investigation. The doctor must also be satisfied that the patient has given consent.
  3. Respecting the rights of the patients to be fully involved in decisions about their care.

However, occupational health doctors also have an obligation to their employers, to the workforce in general and to the public. Just as any doctor must not lie or provide dishonest reports for a patient in an attempt to gain state benefits inappropriately, an occupational health doctor must not lie on behalf of a patient to prevent them from losing their job even if the patient believes this would be in their best interest.

An occupational health doctor (whether employed by an organisation or providing services as a contractor) has contractual obligations to managers as well as their responsibilities to individual patients. This dual responsibility may at times be difficult for an employee or employer to understand. The occupational health doctor has a duty to the individual to provide an independent opinion on clinical matters. This impartial position is of benefit to both the employer and the employee and the dual role the doctor holds should be explained clearly to both parties.

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