Educating the Physicians

When employees report an illness or injury requiring lost time, the employer makes sure they have the necessary forms and assumes the leave will be handled efficiently. With respect to the insurer or TPA that handles these leaves routinely, that assumption will usually be borne out. But does the employer also assume that the employee’s doctor is aware of the physical demands and material duties of the job and can make an informed recommendation? Sadly, in most cases, that assumption will not be borne out.

Most people spend a good third of their day working, so it would be important for the treating providers to know what their patients do during that time and how their current condition impacts their work. But this is seldom discussed in office visits, which are almost always focused on strictly medical issues. The average physician spends perhaps 15 minutes with the average patient—and often less. When the issue of work comes up, the provider will typically ask the patient if he needs time off work: Who knows better than the patient?

But aren’t there guidelines for determining if someone can actually do their job given his current functional status? There are guidelines from resources such as MDGuidelines and ODG for disability durations, but most primary care practitioners and other clinical providers are not aware of them, and do not rely on these resources. Regardless, those guidelines are not intended to address specific restrictions. Occupational medicine is not part of the standard medical school curriculum; it is a post-graduate training specialty.

Essentially, your employee goes to the doctor and hands over forms to complete. These forms ask how many pounds he can lift; and other questions such as how long he can sit, stand, or walk. Since the providers likely have not been trained, how do they approach these questions?

There are ways to get to better outcomes. One way is through communication with both injured employees and providers so that everyone understands what is needed. You, as the employer, are allowed to provide information to the physician. Providers may be leery of discussing medical issues because of HIPAA (which is appropriate), but while you do not need to know the details of the employee’s medical condition, you are entitled to know the restrictions being recommended, and you are entitled to provide information to make sure the doctor relies on valid data when making recommendations.

Go ahead and provide the doctor with job descriptions or job analyses that specify exactly what the employee does during the work day. A word of caution, though: In many companies, job descriptions are woefully out of date. It is not unusual to see references to filing and faxing for office jobs. We saw a cartoon recently that asked a question many millennials might ask: What’s a fax? Bring these documents up to date.

For companies in smaller towns or where many employees go to the same small set of practitioners, invite the doctors for a tour of the facilities to give them a good look at the jobs. Doctors, like most people, rely on their own experiences where they can. If a patient tells the physician that he’s an electrician, the doctor may think of the electrician that came to install the lighting at her house, but there are many different kinds of electricians. Doctors can be educated, and most welcome the opportunity.

Your carrier’s case managers can also help. Indeed, because nurses bring to the table a very high level of trust by all parties (84 percent of Americans rated the honesty and ethical standards of nurses as "very high" or “high" in a 2018 Gallup poll), and because case managers make it their business to find out exactly what jobs entail, they are uniquely qualified to teach physicians what they don’t know and make sure everybody is on the same page with respect to job demands