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December 2006 | |
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Interview: Flying High Unions: TUF on Toll Industrial: Forward to the Past Economics: Debt and the Economy Obituary: The Charlatanry of Milton Friedman Environment: Low Voltage Legal: The Fair Deal Review: A Little History
The Soapbox Parliament Health
Seven Year Itch
 One Reader, At LeastBoss With a Heart
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Health Sick System
I recently spent a horrid Friday afternoon at my Sydney medical centre. During a consultation with a patient injured at work I was pressured for almost two hours by a 'return-to-work' co-ordinator and insurance case manager to hand over my patient's care to the insurer and speed up her return to work - although the employer clearly had no suitable duties. My patient was in tears. I was exasperated. Even worse, the non-medically trained bullies promised to return in two weeks to make sure we followed up on their instructions. Sadly, it wasn't an isolated incident. Australia's new employment landscape is becoming a nightmare for sick and injured workers. Patients no longer feel safe about taking time off work when they are sick. It may be concern about job security or anxiety about being labelled a malingerer at work, or just the fact that there is no one else to cover for them. "Just give me one day Doc, but I'll probably go in anyway," is a common remark. Even when rest is the only answer for a nasty virus, patients often ask for antibiotics over a medical certificate. New federal IR laws that undermine job security and shift the balance of workplace power further toward employers are partly to blame. But employers are also taking advantage of changes to state workers' compensation laws giving greater powers to insurance companies and employers over patient management. Indeed, it seems a new industry has sprung up around workplace injuries, putting company profits ahead of employees' health. It's nothing short of a scandal. My colleagues and I have noticed a sharp decline in the number of people requesting a Workers' Compensation Certificate following an injury at work. If a claim does go in, the doctor and patient are bombarded with calls, faxes and requests for information or a medical report from the insurer and the 'rehabilitation provider' - organisations contracted to insurance companies to monitor work injury cases and assist with return to work. In many cases - typically in large organisations - injured employees are pressured to attend a 'facility-nominated' doctor on the company payroll. This is an abuse of a patient's right to see a doctor of their choice and leads to fragmentation of care. A person's regular GP is best placed to treat them for a workplace injury, taking into account medical history and pre-existing illnesses like diabetes or a weak heart. But even injured workers treated by their own GPs aren't safe. Company-hired 'return-to-work' co-ordinators and insurance claims clerks have been given greater powers by WorkCover to act as case managers, including visiting - in many cases harassing - patients and doctors. Employers and insurance companies are riding roughshod over the system. One patient of mine, an airport worker, saw a company doctor when she was injured and was told there wasn't much wrong and to go back to work. She later found that, without her knowledge or permission, he had rung the employer immediately after the consultation to pass on her personal medical information. Another injured worker recently turned up at our medical centre because his own doctor was fed up with the harassment he'd received over the patient's on-going workers compensation claim. Three treating doctors, including an independent orthopaedic surgeon, had recommended an arthroscopy - a simple operation - on his knee. The insurance company doctor disagreed, and the insurer denied liability for the procedure.
Changes to the IR laws and worker's compensation system seem weighted towards the interests of employers and insurance companies. It has become a sick system. Profits of the insurance companies are booming and the private health system is awash with money - much of it being taxpayers' money. Insurance companies are treating patients and their doctors (those not tempted by lucrative company deals) as the enemy. It is not just a loss for working families, our patients and the health system; but for justice, compassion and a fair go. Dr Costa works in General Practice and Occupational Health; and is National Vice President of the Doctors Reform Society.
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