1 Primary Care Today Conference, May 6-8, 2004 Disabilities Management – Work & Health, Health and...

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Improving Ontario’s medical education

in work and health

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Primary Care Today Conference,May 6-8, 2004

Disabilities Management – Work & Health, Health and Work

Presented by:Dr. Lisa Doupe MD DIH DOHS

Funded by Skills Development Canada, Ontario Region in cooperation with the Ontario Medical Foundation

A Work in Progress

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in work and health

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Objectives:

1. The Framework for Disability Management

2. Our roles as physicians in the RTF/RTW system.

3. Disability-related forms

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ADD DefinitionPAST:

Medical model Impairment perspective

Social Model perspective Environment

NOW:

BIO – PSYSCO-SOCIAL MODEL

See Defining Disability: A Complex Issue at http://www.hrsdc.gc.ca/en/hip/odi/documents/Definitions/Definitions.pdf

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in work and health

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Present System Complex & Incoherent

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in work and health

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The causes of work disabilityDisability = multifactorial problem

Workplace

WCB/insurer Health care system

Worker

Interactions between stakeholders in the disability problem (Loisel et al, 2001)

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in work and health

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OMA Position POSITION IN SUPPORT OF TIMELY RETURN TO WORK PROGRAMS &

THE ROLE OF THE PRIMARY CARE PHYSICIAN March 1994

1. When the patient is off work due to sickness or injury, he/she would bring an employer's proposed return to work program to his/her physician.

2. Physician provides objective reports on impairment, medical restrictions, and other supporting advice to the employee.

3. Employer offers the employee a plan for returning to suitable work in a timely fashion.

4. Employee and management have a primary responsibility to initiate a timely return to work which incorporates input from the physician.

5. Management control of "sick leave" abuse is through work place "culture"" and timely return to work programs, not medical certification.

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in work and health

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“Injury/Illness and Return to Work/Function: A Practical Guide for Physicians”, PEPWH

“As a physician, treating an injured/ill worker/patient, your role is to promote, preserve and protect the health of the worker/patient,

To act as an advocate for policies to benefit his or her health.”

Pwr Health Consultants

Need the OMA link no the WSIB

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Physicians’ Role in Return to Function, Return to Work

8 Steps1. Assess

2.Diagnose

3.Treat

4.Support a return to work/function plan

5.Monitor

6.Report

7.Communicate

GETAN OMA LINK -- http://www.wsib.on.ca/wsib/wsibsite.nsf/LookupFiles/DownloadableFilePhysiciansRTWGuide/$File/RTWGP.pdf

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Occupational Medicine

• A preventive medical discipline that deals clinically and administratively with the health care needs of workers individually and in groups with respect to their working environment, and involves the recognition, evaluation, control, management, prevention and rehabilitation of occupationally related diseases and injuries.

Reference L. Cheung, MD FRCP


GIVe creadait to Lily

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Basic sciences central to occupational and environmental

medicine

• Toxicology• Epidemiology• Biostatistics• Occupational hygiene• Ergonomics• Science of accident preventionReference L. Cheung, MD FRCP

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Clinical Competencies

• Expertise in taking occupational and environmental history

• Familiarity with the diagnostic procedures essential to the evaluation of occupationally related diseases and injuries

• Knowledge of assessing workplace and environmental exposures and hazards

• Knowledge of management and rehabilitation of occupational and environmental diseases and injuries in workers.

Reference L. Cheung, MD FRCP

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Knowledge of Workplace Exposures

• Recognition, evaluation, control and management of the following exposures:

- chemical - biological - physical

- psychological stress• Requires knowledge of toxicology and

occupational hygieneReference L. Cheung, MD FRCP


add pshycholigacl

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Professional Organizations in Occupational and Environmental

Medicine

• The OMA Section on Occupational and Environmental Medicine http://oma.org

• The OMA Committee on Work and Health• Occupational and Environmental Medical

Association of Canada (OEMAC) http://www.oemac.org/

• Ontario Component Society of American College of Occupational and Environmental Medicine (ACOEM) http://www.acoem.org/

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1. Assess– W-H-A-C-S

•What do you do?•How do you do it?•Are you concerned about any of your

exposures on and off the job?

•Co-workers or others exposed?• (How) satisfied are you with your job?• (Or: How stressful is your job?)

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Diagnosis and treatment ---- TOOLS

Depression and Anxiety HAM –D Tool Kit from Wyeth/ Ayerst

Shoulder and upper limb problems– http://www.dash.iwh.on.ca/

Back Problems - http://www.backguide.com/

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Forms

• Sickness certificates

• Return to work forms

• Short and long term disability forms

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A Business Perspective: From Ability to Disability

At work

High

prod

uctiv

ity

Avera

ge

prod

uctiv

ity

Prese

ntee

ism

Causa

l abs

ence

Short

term

disa

bility

Long

- ter

m

disa

bility

Canad

a Pen

sion

Plan

Disabi

lity

Off work

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Consent, confidentiality & liability

Sickness certificates – Patient must give consent for

information to be shared with employers or insurance companies (Ontario Health Information Protection Act)

– Physician opinions = expert = liability– Reference CMA, CMPA, Manitoba College

of Physicians and Surgeons– OMA now developing a guide

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New ACOEM guidelines

http://www.opot.org/guidelines/anxiety.pdfhttp://www.gacguidelines.ca/ http://healthnet.umassmed.edu/mhealth/HAMD.pdf

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Return to Work Forms

• Physician provides functional information

• Employer determines return to work date

• By law, employee must cooperate (see WSIB)

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Key Insurance & Benefit Forms

• Insurance Bureau of Canada

• Canadian Health and Life Insurance

• Workers’ Safety and Insurance Board

• Canada Pension Plan

• Ontario Disability Support Program

• Ontario Works

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Summary

• Disability is very complex

• Disability is not disease

• Physicians have a key role in return to function/return to work

• Stakeholders have a key role in preventing disability

• Solutions are a work in progress

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Thanks

• To all the partners and stakeholders of the Round Table on Safe and Timely Return to Function/Return to Work

• To the Physicians Education Project on Work and Health

• To my staff

1 Primary Care Today Conference, May 6-8, 2004 Disabilities Management – Work & Health, Health and...

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Transcript of 1 Primary Care Today Conference, May 6-8, 2004 Disabilities Management – Work & Health, Health and...