doctor-patient relationship core problem of the workcover system

doctor_patient_workcover

Quite often the lack of a bonding and lasting doctor-patient or doctor-injured worker relationship is a central part…and —often— a central problem…of the workcover system. Quite often the injured worker did not choose to see their doctor or specialist, and the reverse is also true, quite often the doctor did not choose nor want to see this injured worker…

Doctor-patient relationship: core problem of the workcover system

Having worked in the medical field, I used to find it troubling how (many) surgeons function, they operate and treat patients often with very little information about that patient. In other words, they seem to treat a condition without knowing the patient (or in our case: the injured worker) behind the condition. Perhaps it’s easier to cut and hack into people when you know nothing about them?

As a seriously injured worker, and “low-hanging fruit” (the term used by WorkSafe VIC’s CEO to refer to “long-term clients”) of the workcover system, I find it equally troubling and have difficulty understanding how an ‘independent medical examiner’ assesses and makes opinions about our injured condition(s) without knowing us -the injured worker- behind that condition.

What I/we want to say, based on the above observations, is that basically, if you were to change the clinical doctor-patient / doctor-injured worker relationship from one in which  both the injured worker (patient) and the doctor choose each other and $ money $ changes hands directly, you would undoubtedly change the nature of that relationship – both in terms of investment and accountability, and in both directions. It is human nature.

A private paying patient will invest time in knowing who the doctor is, what they do well and their expectancies; AND vice verse: a privately paid doctor will invest time in getting to know YOU, what YOU do well, YOUR coping skills, YOUR coping limits, resilience and YOUR expectancies.

But, as is the case with our workcover system, when external parties manage referrals (e.g referral to an IME, Rehabber etc), payment and approval, the foundation for a doctor-injured worker relationship has been completely changed.

Is that “bond” now between doctor and injured worker (patient), or between doctor and a faceless payer? I, and many other njured workers perceive it as the latter: doctor and faceless payer. And a LOW paying, extremely bureaucratic faceless payer (aka the insurer) as well!

The lack of a bonding and lasting doctor-injured worker relationship is a core feature…and core problem…of the workcover system indeed. Quite often the injured worker did not choose to see this particular doctor (from IMEs to GPs, specialists and allied healthcare practitioners), and the reverse is also true. Think about the list of perhaps 3 rehabbers you receive from WorkSafe Vic, think of the IMEs you are sent to, and think of the increased difficulty injured workers have to find a doctor/specialist that is actually willing to take on workcover patients!

aworkcovervictimsdiary receives many stories about damaged relationships with their own treaters, especially if they don’t recover fast enough. Some treaters become overtly hostile towards injured workers, blatantly discriminate against them and worse, simply because the injured worker does not pay the treater privately, and because the faceless payer pays very little in comparison to private fee schedules. Sadly many treaters do not understand that injured workers cannot use their private health insurance or even Medicare, as this would be seen as committing fraud! One such a story stands out: a severely injured worker with mainly orthopedic injuries was told by his orthopedic surgeon, after the 1st failed operation, that he needed to come in “last” (last patient); that “he sucked up valuable time” – (did he realise how many private patients he could see and how much money the surgeon could make if it wasn’t for the injured worker’s long(ish) consultations because of the ‘paperwork’), and eventually that his ‘consultations’ would be limited to ‘7 minutes’ (timed). Now, how do you want a literally ‘trapped’ injured worker to have faith in his surgeon, and to recover both physically and mentally?

While we, injured workers, initially approach our ‘treating’ doctors and other treaters with a fair amount of hope and optimism, this all too often, rapidly turns to doubt and suspicion when the injured worker senses that there is a lack of personal investment from their doctor, or allied healthcare practitioner. Many injured workers begin to believe that the primary relationship of this doctor/allied healthcare practitioner is with this third party – the workcover insurer.

Countless injured workers also sense (and know) that some doctors and allied health practitioners- in particular independent medical examiners,  rehabbers, vocational assessors etc -want  more referrals from this third party (workcover insurer) and that their investment is in pleasing them and not you, the injured worker.

If you’re unfortunate enough to fail to improve (by the text book), or you improve more slowly than anticipated, the doctor/treater is vulnerable to doubts about you, and often those doubts are unfairly magnified by the ignorant comments of others. The system not only lacks attachment or bonding between doctor and injured workers, it becomes adversarial and from the injured worker’s perspective, covertly or not so secretly colluding.

It is well known that, at least statistically, private patients recover and even return to work more quickly when they know they simply have no alternative but to do so or lose all income and worse. Doctors know this as well. But what many doctors don’t know or don’t understand is that the adversarial nature of the workcover system impedes injured workers’ recovery! In fact I have no doubt that being ‘in or on the system’ makes you sick!

The other aspect of this relationship is total transparency, with virtually NO privacy protection of your medical records. Most injured workers know this, and it impedes sharing of ‘private’ histories such as marital, financial and social problems, out of fear that it will be taken out of context and use/abused by workcover against the injured worker. This withholding of some personal info also changes the nature of the treater-injured worker’s relationship, including that of a psychiatrist or psychologist-injured/ill worker relationship.

Saying that, I/we do of course acknowledge and THANK those medical and allied practitioners who genuinely care for their workcover patients, even though they are paid lowly by a faceless, convoluted, adversarial and extremely bureaucratic party.

 

[Article dictated by WCV and manually transcribed on her behalf]



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2 Responses to “doctor-patient relationship core problem of the workcover system”

  1. I dont think the Dr’s I see including my GP get paid less for workcover consults….I pay $170 per GP visit which is double the fee for a normal consult.
    Speaking of specialists discriminating when they know you are on work cover…YES I to have had this happen…He made feel like a criminal and useless scammer….had he bothered to look at my injury as awhole instead of 1 injured area he would have found the fractures I have been forced to hobble around on..I also look at the specialist that found fractures and ruptured ligaments in ankle he was biased also and stated that my knee should now be pain free…Well hello both are still sore and swollen like rockmelon …I ended up ringing all over Australia finding a specialists for these areas and low and behold he actually found I do have a problem with both areas and his consult fees are cheaper than my Gp’s including report writing fees

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  2. I have opted to go public for some of my problems, simply because it’s too hard to get some pretty sensitive issues dealt with without going to conciliation… I for one don’t wish to have to explain some of these issues with my legal team and goodness knows how ever many Drs therapists CM would think I should see. I keep records of all this and when the time is right it will be presented. I am also over having to wait approval for procedures that need to be done now not 6 – 12 months later. My treaters understand this and are happy to bulk bill, or I pay myself, this will have to stop as I don’t have any savings left and only enough super to keep my policy open for income protection and TPD when it’s time.

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