Occupational Medicine: A Specialty Service

Michael Davis - IWIRC Corp.

In 2005, I wrote an article for iBi entitled “Did Your Dermatologist Deliver Your Baby?” IWIRC has always striven to distinguish itself as an Occupational Medicine (OM) specialty service. In doing so, we seek and develop providers who possess skills and mindsets that differentiate them from family practice, emergent and urgent care. They serve a dual role: ensuring the safety of the worker, and reducing work injury exposure risk for the employer.

There are a host of specialists in the field of medicine. Pediatricians, for example, intimately know the issues of children and understand the care requirements that differentiate a child’s needs from adults. There are also many general practitioners (GPs) who provide care to children for routine health and well-being. However, when a case becomes complex, the GP recognizes when it is best to allow a pediatrician take over.

This is also the challenge for employers and their questions regarding OM. When is a GP appropriate? Are all physicals the same? Not really. Specialized and employment-required physicals are not the same as those needed for school or life insurance.

Undisclosed or unidentified medical concerns, such as hernias, and previously assigned permanent work restrictions may be mistakenly overlooked by the GP, but are a significant concern of the OM provider. In Illinois, a worsened pre-existing condition that develops into a chronic medical issue because of a work-related cause may become the responsibility of the employer (and the workers’ comp insurer)—not just until retirement, but beyond… until death.

The same holds true for first-time injuries. OM or GP? Many GPs don’t identify issues such as OSHA reporting, modified duty opportunities or the overall goal of care: returning to one’s previous occupational baseline. Oftentimes, their approaches to conservative care are not consistent with best practices. They may even be more expensive and poorer in outcome. Again, OM or GP?

At a recent OM social event, the conversation turned, as it often does, towards work. The discussion centered on the differences between OM providers and our GP friends. I commented that part of the OM provider’s care is to validate the veracity of the circumstances reported in the injured worker’s complaint. One OM provider became especially indignant: How could I ask medical providers to treat their patients as if they were lying? Wasn’t that inhumane? Wasn’t I treating all workers like criminals? They walked out before I could even respond.

As the co-owner and clinical manager of an OM clinic, I would never ask providers to do anything less than give their best effort in treating the injured worker. I do ask, however, that they utilize their OM skills to ensure that every patient receives appropriate care based on the objective medical findings and information available. OM is no different from other specialized care. Expecting generalists to provide care in specialized circumstances invites unintended consequences, unwanted side effects and inefficient outcomes—much like asking a dermatologist to deliver a baby. iBi

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