Without the full and informed consent of the patient, the AMA generally sees no role for an employer in our consultation room.
The elephant in the consulting room
by Steve Hambleton, President, AMA
I was recently asked to speak at the ACTU Work Health Rights Summit inMelbourne.
It is not often that an AMA President gets to address ACTU gatherings, but the rights of workers when it comes to their health is common ground for the AMA and the ACTU.
My invitation to the Summit followed media reports of employers wanting to accompany their workers to doctor appointments. I was quoted as being against such a move – for the obvious reasons.
Not only would it be a major attack on the doctor-patient relationship, it exhibits a troubling lack of trust between employer and employee.
A few years ago we were having trouble getting businesses to take an interest in the health of their workers and to engage properly in the process.
But now it is likely that the pendulum has swung too far and that, in some cases, businesses are over-involved in the health of their workforce.
Some are almost at the stage of chaperoning their workers when they visit the doctor.
This approach has led to reports of bosses actually wanting to sit through the consultation with their employee and, in some cases, trying to alter their medical certificates to get them back to work sooner. This is not a positive development.
The AMA sees the role of the doctor as being first and foremost to consider the wellbeing of our patients.
Patients entrust themselves to our medical care, often in a vulnerable state of illness or injury.
Good health care will result from a close collaboration between the doctor and the patient.
We are bound to maintain our patients’ confidentiality and our role is to act as an advocate for the patient in what is often a complex health system.
Our professional independence is critical to good patient care.
The AMA Code of Ethics also demands that we must safeguard our clinical independence and professional integrity from the increased demands from society, from governments, or from other third parties for the benefit of individual patients.
Our clinical independence is essential when choosing the best treatment for those patients and defending their health needs against all who would deny or restrict access to care.
I have never personally experienced an employer accompanying someone who was ‘sick’, but have certainly seen on a regular basis patients attending with the safety officer’ or the ‘workplace rehabilitation coordinator’, who have often wanted to enter the consulting room with the patient.
By the very nature of the employer-employee relationship, the power is in the hands of the employer and the situation could be perceived as quite threatening, invasive, and coercive (even if unintended) to the employee (and possibly to the doctor as well).
There is the very real prospect that the employee may be in fear of repercussions from their employer.
From a practical perspective it also poses further real risks to the employees’ right to privacy. In a medical consultation, there is every chance that the history will necessarily explore personal information that may be relevant to the consultation, but not relevant to the employer.
In response to this situation, the employee may feel the need to withhold or alter personal information in the presence of their employer in order to maintain their privacy.
This may have adverse health outcomes and could easily undermine the doctor’s assessment.
In addition to an appropriate history from the patient as part of the relevant physical examination, the employee may be required to undress to some degree to be appropriately examined.
There is no doubt that if an unrelated third party was present that the behaviour of the doctor or the patient or both would change.
In circumstances such as these, our patients rely on us to advocate for them, and it would be entirely appropriate for the doctor to insist on seeing the injured worker alone to take that additional pressure off the patient.
In most cases with an unrelated third party in the consulting room, there is great potential for harm – with little in the way of potential benefit to justify the risk.
I think it best that we work to promote better trust about health issues in the workplace.
Employers providing transport and support and information can be a good thing, and it can enhance health care – but we definitely don’t need that elephant inside the consulting room.