Discussing Work Contribution: Part 4

Blog - Discussing Work Contribution: Part 4

Dr Mary Wyatt | Published: July 28, 2015
First of all, policy makers need to get interested in this area. Taking the lead on this is a significant initiative, so I think it is up to the policy makers to map out a plan. They need to involve a number of subject matter experts, including research specialists and people with the capacity to translate research, and it would need to be collaborative.
Medical specialists can also make a substantial contribution. Organisations such as the Faculty of Occupational and Environmental Medicine possess the knowledge but not the funding ability. 
The Dutch have created a ‘one-pager’ on work contribution to back problems.  Whatever you think of the merits of the research they have used, they have been able to come up with an agreed list of activities which they consider contribute to back problems, and have agreed on the extent to which they contribute.
If Australia can get to some sort of shared agreement on which activities undertaken are likely to result certain health problems, then at least we have a reasonable starting point and a resource which everyone can access and use. This is bound to be better than an individual doctor’s beliefs based on his or her own experience, or a poor understanding of the research.
We also need to get a better handle on the history used to assess situations. In Blog Post 1, I talked about how the verbal history of prior medical problems is pretty unreliable. I’d estimate that it is about 50% reliable, varying according to the situation and health problem. We need to develop a way of accessing health records which also sympathetically addresses patient privacy and confidentiality.
We need to ask treating doctors about the earlier history as standard practice.  We also need to pay doctors for the time it takes to review earlier clinical records, or come to an understanding with the patient about reviewing their entire clinical notes.
Additionally, we need to recognise that providing an opinion on work contribution needs significant expertise.  It takes a long time to review the literature, and only a minority of doctors have done this / have time to do it / have access to relevant research.
Some general practitioners will sensibly say they do not have the expertise, but most will go ahead and provide an opinion on work contribution without understanding relevant occupational risk factor research. Similarly, other specialists who have not reviewed the literature may provide an opinion, without having researched the area in depth.
Evidence based medicine now provides a solid platform for treatment decisions.  It is not always used but we know it is there and we commonly talk about the evidence for treatment.
It is time the same methodology was applied to the assessment of work contribution.