Utilize diplomacy to get what’s best for patient
When an employer or client resists good occupational medicine, providers may have to become diplomats to get things done, suggests Robert McCunney, MD, MPH. McCunney is director of environmental medicine at the Massachusetts Institute of Technology in Boston and president of the American College of Occupational and Environmental Medicine (ACOEM) in Arlington Heights, IL.
First, he recommends following the guidance of ethical codes provided by ACOEM and the American Association of Occupational Health Nurses in Atlanta. Those codes require physicians and nurses to protect their patients’ interests even when the employer resists. And McCunney suggests that you can even use the ethical codes to bolster your position.
"You can show them that, as an occupational health professional, you’re bound to this code of conduct that requires you to do the right thing for the patient," he says. "Sometimes that defuses the argument some by showing that it’s not just you against the company. You don’t have any choice but to do this for the patient."
It also can be helpful to just explain some of the practical aspects of the situation to the employer, such as the likelihood that the worker will appeal a workers’ compensation denial and eventually receive coverage anyway. Employers often do not understand that you only have to prove a likelihood that a disorder or injury is work-related, not that it is an absolute certainty, he says. When you explain that, the employer may understand that there is no need to fight the diagnosis, McCunney says.
"You can explain that they will eventually pay for it anyway, so they might as well take the high road and do the right thing," he says. "That way they can gain whatever benefits there are from that. That’s better than paying the money on appeal and looking like you didn’t care."
The physician’s ultimate responsibility always is to the patient, McCunney says, no matter what that means financially for the employer or client. But he cautions against an adversarial approach in which you insist on one course of action simply because you are the medical professional.
"That’s a prescription for failure, definitely not the best approach to take, especially in a non-medical environment," he says. "You clearly have a unique perspective, but being highhanded can just alienate people. It’s tempting to do that when you’re sure of the diagnosis and don’t want to back down, but sometimes you have to be able to work with the employer without backing down."
McCunney says you have to find "productive ways to do what’s right for the patient within the framework of the employment situation."
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