UBC Objectives: Family Medicine & Priority Topic: Disability

By the end of postgraduate training, using a patient-centred approach and appropriate selectivity, a resident, considering the patient’s cultural and gender contexts, will be able to...

• Demonstrate the application of basic occupational disability prevention and management principles and practices in clinical settings
• Demonstrate an understanding of the impact of occupation on the health of an individual and the impact of health on work

Disability
Key Feature 7: Do not limit treatment of disabling conditions to a short-term disability leave (i.e., time off is only part of the plan).
Skill: Clinical Reasoning, Patient Centered
Phase: Treatment

Every Canadian province has their own workers' compensation organization, so details of occupational disability management will vary between provinces. WorkSafeBC is the provincial workers' compensation organization in BC. Per the Doctors of BC/WorkSafeBC Agreement, WorkSafe BC "...has the authority to provide health care and rehabilitation services to workers who sustain injuries that arise out of and in the course of their employment." (Doctors of BC is a voluntary medical association that any physician practicing in BC can be a part of. Their mandate is to promote the interests of physicians working in BC.) The Physician Reference Guide for the Agreement explains, "Working with Physicians and Employers in this province, WorkSafeBC’s goal is to facilitate a safe, timely, and durable return to work for injured workers (...) When a person suffers a work-related injury or contracts a work-related disease, he or she can make a claim for compensation to WorkSafeBC." In BC, a claim would be submitted by a physician who assesses the patient and submits a Form 8 to WorkSafeBC. Further follow-up appointments ask the physician to submit a Form 11 to WorkSafe BC if the following conditions apply:

• There is a change in medical condition
• There is a change to the Worker’s treatment plan
• There is a change in Return to Work status
• It has been more than 4 weeks since the last Form 11 was sent, or
• A Form 11 is requested by a WorkSafeBC Officer

Of course, like any other injury, the physician doesn't have to address a patient's concerns through WorkSafeBC, and can treat the injury much as any other presenting complaint. However, there is in incentive for all parties, including physicians (receive better compensation for the office visit when submitting a claim through WorkSafeBC), patients (WorkSafeBC expedites investigations, specialist appointments, and treatments compared to the normal public healthcare processes, all important parts of the comprehensive rehabilitation process), and society (by holding employers accountable for the safety of their employees).

As a primary care physician working in BC or any other Canadian province, or any other region of the world, along with treating injuries and diseases, one of my main priorities is also to try to prevent patients from acquiring new injuries and diseases. When I am gathering my social history on patients in clinic, I ask about employment conditions and if there any possible hazards that could lead to injury or disability, which include the following types of hazards:

• Chemical hazards (ex: organic solvents, metals, asbestos, toxic gases) 
• Physical hazards (ex: noise, vibration, radiation) 
• Biological hazards (ex: blood or other body fluids, animal and bird droppings) 
• Ergonomic hazards (ex: awkward postures and movements, poor lighting) 
• Psychological and work organization hazards (ex: workplace stressors, workplace bullying) 

If hazards are identified, it is then part of my duties to try to work with the patient to create a plan to eliminate or mitigate harm from them.

The possibility of injury or disability from employment is not a rare phenomenon. According to the peer-reviewed article "Individual, occupational, and workplace correlates of occupational health and safety vulnerability in a sample of Canadian workers" by Lay et al. published in the American Journal of Industrial Medicine in October 2015, "Occupational injury, illness, and workplace fatalities are important public health concerns. Globally, 2.3 million deaths a year can be attributed to occupational injury or work‐related diseases, and many more millions suffer from non‐fatal work‐related injury and illness. Annually in Canada, an average of just under a million lost time occupational injury claims are accepted by provincial workers’ compensation agencies, representing one in 46 full‐time workers being compensated for an injury severe enough to miss one or more days of work. The consequences of work‐related injury and illness extend beyond individual workers, exacting important social and economic costs from families, businesses, and economies." The impact of occupation on the health of an individual and the impact of health on work is significant and common among the general population, and it is therefore under my purview as a family physician to consider how my patients and society may be impacted by and occupational injury and disability.