Letters to the Editor |
Re: Professional competencies
Dear Sir,Gallagher et al. [1] attempt to define an occupational health physician (OHP) by reference to the specialized core competencies that may be required. One mandatory area of professional competence is also one of professional ambiguity for OHPs. In what respect, extent and how do OHPs care for their patients/clients?
OHPs are ‘doctors’ with professional ethics of responsibility and duties of care to patients/clients (Good Medical Practice). However, it is acknowledged that these duties can be strained and possibly distorted by responsibilities to the businesses we advise and increasingly the service provider that the doctor may work for.
It is the latter's relationship and influence that is potentially most ambiguous and difficult. As the ‘middle men’, service providers sign contracts promising reports to clients in terms of quality and expectation but reduce consultation times on purely business/profit criteria. Something has to give and it is the wider role of doctor as carer (and related duties) that in my experience is least valued and is expected to go first. This is of concern as more qualified OHPs are likely to find themselves working for service providers with their role being increasingly reduced to the equivalent of benefit assessors.
Perhaps, we need to consider and define what caring entails for OHPs. It is not unusual to find a few minutes explaining a condition or exploring an emotional reaction leads to therapeutic benefit that has a lasting affect on that individual and future circumstances (a stitch in time). In my opinion, this is worthwhile being beneficial to the patient, professionally satisfying and will lead to a more comprehensive understanding and better report. It is also caring as it is done in the patient's best interest. This does, however, take time leading to a falling behind on appointments with consequences which may affect following consultations. It can also lead to complaints as insight gained, beliefs or behaviour explored can release an angry reaction.
Some may argue that this type of caring is a ‘bolt on’ service and not offered by their organization. OHPs may need to clarify with their employer the role expected of them. Some or many may refuse such a limited involvement.
The challenge for the speciality may be to specifically define the core content and boundaries of occupational medical care irrespective of context and doctors may need to stand firm in protecting their ability to deliver it.
e-mail: richardcol{at}doctors.org.uk
References
- Gallagher F, Pilkington A, Wynn P, Johnson R, Moore J, Agius R. Specialist competencies in occupational medicine: appraisal of peer review literature. Occup Med (Lond) (2007) 57:342–348.[CrossRef][Medline]
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