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Competencies in Occupational Health/Health and Work for medical undergraduates

Competency 3 - Good Clinical Care: Communication

Objective: to develop reflective communication between healthcare professionals, employers and employees

KNOWLEDGE:

Understand the need to explain the difference between occupational health and clinical consultations .

All medical consultations are bound by confidentiality regardless of where they are held; whether it is a GP surgery, a hospital, or a room in the place of employment.

Almost all medical practice depends on the willingness of the patient to disclose personal and often sensitive information to the doctor. To enable the patient to make those disclosures the doctor must be explicit that he/she treats such information as confidential.

A clinical consultation is a consultation between an individual and a medical practitioner, where the practitioner is responsible for the clinical care of the patient. This includes investigation, diagnosis and providing appropriate treatment and management. The relationship between the practitioner and patient is seen as therapeutic.

An occupational health consultation however, is somewhat different. The occupational health physician is not responsible for the clinical care of the individual. The aim is to understand and address any concerns that might relate to the interaction between health and work. During an occupational health consultation the doctor does not provide medical treatment for the employee. In addition, when an occupational health consultation is undertaken the doctor has obligations not only to the individual, but also to the employer who is seeking an opinion and to the public in terms of safety. The doctor does however have a responsibility to put the interests of the patient first and remains bound by the rules of medical confidentiality. This in itself can raise numerous conflicts of interests. It is therefore essential that such consultations are conducted impartially, where by the doctor provides an independent opinion to all parties.

Consider the example below:

A 23 year old man who is a diabetic on insulin, is being considered for shift work.

1. The occupational health consultation would assess his suitability to carry out the duties required of him whilst on shift work, and issues relating to management of his diabetic control whilst working shifts, ensuring the safety of the individual, co-workers and the public. Part of the assessment would include questions related to the management and control of his diabetes, as these factors are important in assessing his fitness to perform shift work. However, alteration to his treatment regime would not be within the remit of the doctor. Any concerns relating to treatment would be referred to the doctor involved in his clinical care.
2. The clinical consultation would assess the individual in terms of his diabetic control and management only.