Without the Whitecoat
Returning back to work... who makes the decisions
We all feel that any doctor can just keep on giving out medical certificates for workers so that they could return to work. The big question lies on the fact that these physicians are presumed to have undergone a basic course on occupational health and safety and had fully satisfied the requirements of Article 160, Book IV, Title 1 under Presidential Decree 442 also known as the Labor Code of the Philippines. As physicians we become so ignoramus about the Labor Code of the Philippines that governs the practice of occupational health and safety. In our residency training days in Internal Medicine, Surgery, OB-GYNE, Pediatrics and other specialties we have never encountered topics such as hazardous workplaces and materials, or such gig topics as medical surveillance in the work-site safety and health programs. None in the practice of Internal Medicine, but there are still a lot of internists who still see and practice occupational health and safety without any kind of specific trainings. One recommendation to this residency training program is to incorporate industrial and occupational medicine in their residency training programs, since most of these graduates will sit down in offices of Health Maintenance Organization or in any point will be handling workers of industries. I think as physicians we tend to forget that the patients that we see in our clinics are employees and workers, in the first place they earn and take home the bacon, thus they have a job to depend on, then by logic there is the existence of the practice of industrial and occupational medicine.
If we all observe the correct steps on medical surveillance (not offered in residency training programs of Internal Medicine, Surgery, OBGYNE, Pediatrics, but is offered in Family Practice) where medical screening is implemented is the detection of dysfunction or disease before an employee would ordinarily seek medical care, and medical surveillance is the analysis of health information to identify workplace problems that require targeted prevention. (This one thing that separates the general practitioner or the internist for an occupational health practitioner, the latter's practice is only confined to the four corners of his/her medical office, while the other still in his medical clinic with an existing plant infirmary, in where he/she does his/her plant rounds and walk-through surveys and lastly he/she does his/her routine "Housecalls". A good occupational health program includes management commitment, employee participation, hazard identification and control, employee training and program evaluation.
For those who wanted to practice occupational medicine and never had the privilege training in occupational health and safety, primary prevention in the workplace like preventing known hazards from coming into contact with vulnerable employees depends on approximately implemented engineering and administrative controls. With this practice there are measures that the physician have to perform aside from addressing the medical consultation part of the practice, since a lot of internist believe that the medical practice aspect of industrial and occupational medicine are all centered on just consultation and treatment, reading and interpretations of laboratories and returning the worker back to his work, but remember these physicians don't have the slightest idea on the guidelines on the proper way to return the employee back to work.
For those would-be practitioners in occupational and industrial health and safety here is just an algorithm showing the process of "return-to-work". We all start with injury and illness since it is the basis of returning patients to work. If the employee is able to return to work after medical treatment then return to full duty, if unable physician must reach an understanding of patient's job demands through one or more of the following, patient/supervisor interviews, job demand analysis evaluations, and the dictionary of occupational titles. In this process flow the physician authorizes patient to return to work with workplace restrictions such as specific and objective limitations, specialized equipment requirements, duty day/work hour limitations and the time period for restrictions/follow-up. With all of the above if the patient is able to return to work to full work following specified time period then they can fully return to work, if not the physician should consider administering functional capacity evaluation thus cover the translation of medical impairment into functional limitations, and determines patient's work capabilities and work capacity. The physician may require rehabilitation like physical and occupational therapy, work conditioning, and work hardening, with this measures if the patient can go back to work then he/she returns to full duty work, but if he/she cannot after rehabilitation, the physician should consider administering fitness for duty evaluation, thus if the patient achieves maximal medical improvement, if the patient can perform essential task of assigned job, and if the employer can reasonably accommodate the patient in accordance with the "Disabilities Act", then the patient returns to assigned job as modified if the patient cannot the patient may need to consider another form of employment.
If we look upon this guidelines which are not part of any training programs, thus the graduates of this specialties should not in any way practice or return any employees back to the job site or work sites without the knowledge on occupational health and safety. Hopefully, I had made myself clear that's why we are trying to encourage that all physicians who are treating and doing consultations on employees and workers should undergo basic training course in occupational safety and health.