Ongevraagd advies

Unsolicited advice

F.H.W. JungbauerThe occupational health physician can act as interfering busybody. When I read some of the information brochures published by the occupational health and safety services, this is even a function used to acquire customers. Apparently the occupational health physician offers solicited as well as unsolicited advice. The occupational physician has the knowledge concerning the potential health risks of work, so he can also be hired to spot and report these risks. More than our curative colleagues we feel that we have a role to play in the prevention of disorders and the preservation of health. We, as occupational health physicians, feel we have to point out the risks to the ignorant employee and employer, whether they want it or not. To me all this brings to mind the comparison with the happy missionary bringing the ‘joyful message’ to the Papuans a hundred years ago. Now, a hundred years later, we in the West wonder at this arrogance. Can the occupational health physician function as the thermometer to the feverish patient, or do we than act as the naïve missionary? Tell us, whoever knows the answer.

After mainly having worked as an occupational health physician in tertiary care for five years, I have lately, partly, returned to the core of our profession. Recently I have also been spending my time doing surgeries as a first line occupational health physician. Even more often than five years ago these surgeries raise the following questions. What is my purpose in doing this surgery? To which question do I provide an answer and who is actually asking for my advice? Does the employer appreciate my signal about the risks in his company when I identify one, or am I just reassuring government as that is where the legal obligation of my involvement was determined? When I hold a surgery: do I give reintegration advice because the employee does not know if and how he should restart work? Will the employer in that situation appreciate my intervention because otherwise he will not get a healthy employee back to work? I noticed that for many of the occupational health actions there are no explicit questions. Many of our actions follow from collective agreements with the management and from the legal obligations of the employer. We are doing absence surgeries because it has been agreed that we call up the absent employees. We analyse the problem at the core of the absence as the legislator made it mandatory for the employer to involve us. The employee appears in the surgery because the employer wants him to.

Working safely and healthily is a shared responsibility for employee and employer. Assuring a speedy recovery of the work capacity in case of sickness absence is primarily the responsibility of the employee. It seems to me that lately this point of view has only rarely been taken in considering the occupational physician’s (absence) surgery. This cynical view of our actions raises questions. Why have we allowed ourselves to be manoeuvred into this position? We are the experts in the field of work and health! When problems arise with health, absence or work conditions then our knowledge and experience in this area should direct employers as well as employees towards us.

As long as a major part of our work is done without being based on explicit questions or problems from the side of our customers, the effectiveness of our advices and our actions will not be optimal.

A good expert in the field of work and health will act when he/she is asked a question or is confronted with a problem. I see no room in the work of an occupational health physician for giving unsolicited advice.