Occupational medicine and the construction of "difficult reputations"

The structure and process of workers' compensation systems and the role of doctors: A comparison of Ontario and Québec

BACKGROUND

This study sought to identify impacts of compensation system characteristics on doctors in Québec and Ontario.

METHODS

(i) Legal analysis; (ii) Qualitative methods applied to documentation and individual and group interviews with doctors (34) and other system participants (31); and (iii) Inter-jurisdictional transdisciplinary analysis involving cross-disciplinary comparative and integrative analysis of policy contexts, qualitative data, and the relationship between the two.

RESULTS

In both jurisdictions the compensation board controlled decisions on work-relatedness and doctors perceived the bureaucratic process negatively. Gatekeeping roles differed between jurisdictions both in initial adjudication and in dispute processes. Québec legislation gives greater weight to the opinion of the treating physician. These differences affected doctors' experiences.

CONCLUSIONS

Policy-makers should contextualize the sources of the "evidence" they rely on from intervention research because findings may reflect a system rather than an intervention effect. Researchers should consider policy contexts to both adequately design a study and interpret their results. Am. J. Ind. Med. 59:1070-1086, 2016. © 2016 Wiley Periodicals, Inc.

LIMITING OCCUPATIONAL MEDICAL EVALUATIONS UNDER THE AMERICANS WITH DISABILITIES ACT AND THE GENETIC INFORMATION NONDISCRIMINATION ACT

Although medical care delivery by one's personal physician is the paradigmatic American healthcare arrangement, in the workplace setting, many Americans undergo medical evaluations to assess their fitness for duty or degree of impairment. This Article explores the complex and evolving legal status of occupational medical evaluations. Beginning with the legal and ethical frameworks of occupational medical practice, the Article then examines the effects of increasingly detailed legal regulation under the Americans with Disabilities Act and the Genetic Information Nondiscrimination Act on employees, employers, and physicians.

Preserving workers' dignity in workers' compensation systems: an international perspective

BACKGROUND

Workers' compensation systems are among the most generous disability insurance systems in North America, although they are also known to be potentially adversarial and may have iatrogenic effects on claimants. This article examines issues to be considered to ensure fair compensation provided in a way that respects the dignity of workers.

METHODS

An overview of the literature on characteristics and effects of workers' compensation systems is followed by an analysis based on classic legal methods, including those of comparative law, complemented with interview data to examine three models of disability compensation.

RESULTS

The first part of the article identifies cross cutting issues to be considered in the examination of the equity of compensation systems and the protection of the dignity of claimants. These include three underpinnings of workers' compensation: the links between a "no-fault" system and the adversarial process, the appropriate use of medical and scientific evidence in the determination of compensability and the application of appropriate measures for promoting return to work. The second part looks at accident compensation in New Zealand, where compensation is available regardless of the cause of the accident, and disability insurance in the Netherlands, where compensation is available regardless of the cause of the disability. It then describes a composite of characteristics favorable to equity drawn from the thirteen workers' compensation systems in Canada.

CONCLUSION

Systems that succeed in reducing opportunities for adversarial interactions and that provide substantive protection could better promote the dignity of claimants.

Beyond reputation: debate on the role of corporate influence in occupational and environmental medicine

In his article in this issue, Tee Guidotti casts recent works addressing corporate influence on occupational medicine as "collective act[s] of disparagement ... undertaken ... for political reasons." We move beyond the question of reputation to address key conflicts in the history of occupational medicine, including the American Occupational Medical Association's historical role in weakening the beryllium standard and the American College of Occupational and Environmental Medicine's recent efforts to limit the extent of the Family Medical Leave Act. The corporate practice of externalizing health and safety costs makes industry influence an important ongoing topic of debate in occupational and environmental medicine.

"Guidotti fails to convince" on two issues

This is a response to Tee Guidotti's defense of the American College of Occupational and Environmental Medicine (ACOEM) as an ally for workers struggling for safer and healthier work. Guidotti fails to convince on two central issues: a blindness to the powerful impact of corporate power on professional thought and behavior; and a lack of evidence that ACOEM has ever been inclined to collaborate with workers. In addition, Guidotti relies upon his own review of ACOEM's historical archive to support his argument. Unfortunately, access to this archive is limited to those deemed reliable by Guidotti, giving the appearance of an attempt to control both information and interpretation, and calling Guidotti's own "objectivity" into question.

Difficult reputations and the social reality of occupational medicine

This response to Tee Guidotti's (2008) critique of Elaine Draper's 'The Company Doctor: Risk, Responsibility, and Corporate Professionalism' (2003) argues that a forthright examination of the conflicts of those working in the field of occupational medicine is essential to maintaining the health of the profession and to promoting constructive policies. Research for 'The Company Doctor' reveals how doctors walk a tightrope of professional demands on them. The author describes how corporate employment affects medicine and science and how professionals working in corporations are subject to the decisions of company managers and to economic and legal imperatives stemming from their status as corporate employees. Analyzing company doctors' role in confronting toxics and responding to liability fears in corporations, the author argues that problems of lost credibility, stigmatization, and tarnished reputation that company doctors describe largely stem from the organizational constraints, economic interests, and other aspects of the social context of their work. These social forces exert powerful pressure on the ethical framework and daily work lives of these professionals as well as on the reputation of their field. The author discusses ways in which the conflicting demands from being both a corporate employee and a physician are a social and structural problem beyond individual ethics.