Clarifying my message re: doctors, RTW coord, etc.
Jennifer Christian MD
To those of you who wrote me worried notes: I apologize for causing confusion/misunderstanding. I am NOT recommending we “medicalize” disability. I AM pointing out the reality that in order to PERSUADE doctors to take on responsibility for doing their part in the SAW/RTW process, they need to SEE it as a successful outcome of the healing process – as the finale of their MEDICAL work. Thus, they need to see the COHE as part of the healthcare system, and its services as part (an extension) of their “caring” process.
I hope that the two slides pasted below (and attached) clarify the nature of the gap in the social fabric we are trying to patch with RETAIN. I’ve also pasted below (and attached) a one page Work Disability Prevention Manifesto I wrote that describes the nature of the problem AND the nature of the opportunity (solutions) in words.
At the point the RETAIN program begins – a few days or weeks after the worker first seeks care from a physician for a new health condition – the worker, the physician and the employer ALL see any workplace absence as DUE to an unresolved MEDICAL problem. In fact, almost ALL health-related job losses BEGIN with a worker seeking care for “a new medical problem.” As provided by law and usual business practice, doctors play a critical role, especially during the first few weeks/months. Their words to the patient and on disability / RTW forms are powerful; they set expectations. Employers and claims payers expect doctors to make determinations (expressed on forms) that say whether workers may work and if so, doing what. Doctors thus play a major role – and can START the process of SAW/RTW. The COHE then communicates with other parties who must pick up the baton and run with it. Most importantly, the employer decides whether or not to provide work within the workers’ altered capabilities. If things get stuck, the payer or the government (workforce system) can come in to provide practical assistance to the employer or worker.
TRY TO SEE THIS THROUGH THE DOCTOR’S EYES: Physicians are professionally committed ONLY to the practice of medicine --to diagnosis, treatment, relieving suffering, and assisting healing. Period. So the SAW/RTW process needs to be positioned in THEIR EYES as an important milestone in the healing process IN ORDER for the doctors to BUY IN. (I have been working to improve things at the healthcare-workplace interface for 30 years. It is impossible to get doctors to care about an “administrative” or “benefits” or “employment” or “legal” program involving their patients. Those things are simply “someone else’s job – not mine”. Getting doctors to pay attention even to stuff they DO see as MEDICAL is tough enough. Think “herding fretful cats.”)
Diagram #1 shows today’s gap between the doctor’s office and the workplace. Today, neither the doctor NOR the employer feels responsible for DRIVING a healthcare episode in an employed person towards a good concrete outcome: the minimum possible life disruption and protecting the worker’s job. Diagram #2 shows the maze that an affected individual has just entered. Who will help them get through to the other side? Diagram #3 shows that neither the private sector as a whole nor the public sector as a whole has felt responsible for this issue.
RETAIN is an effort to get all parties to recognize that the solution is TEAMWORK – and to start learning how to COLLABORATE across stakeholder boundaries. Each stakeholder group must feel responsible and take professional satisfaction in the eventual SAW/RTW outcome, like it’s part of THEIR job. In other words, preventing needless work disability must be a SHARED responsibility, with each party contributing what they can – and making an extra effort at problem-solving if necessary – to make sure newly injured or ill workers actually get the support they need to stay functional and keep their jobs.
See the two slides and the text of the Work Disability Prevention Manifesto below and attached. I hope this is helpful.
WORK DISABILITY PREVENTION MANIFESTO
Preventable job loss demands our attention!
Why do such poor outcomes occur?
How can we fix this problem?
Now is the time for policymakers in government and the charitable sector, as well as private sector employers, insurers, and health care delivery and related organizations to commit to developing solutions to this national problem.
Thank you. Unless we see the many pieces as a integrated system the outcomes will not improve. (Ref: W Edwards Deming)
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