The role and responsibilities of occupational physicians are very different from those of the general practitioner or other hospital specialist. Table 7.1 Comparison of roles and responsibilities

Function

General Practitioner

Occupational Physician

Diagnosing disease

A major component of day-to-day activity

Not a priority. Discovery of a previously undiagnosed medical condition will lead to communication with the patient’s GP

Treating disease or ill health

A major component of day-to-day activity

(Usually) no place for occupational health in treating disease or ill health, but the occupational physician may suggest treatments or strategies that minimise the impact on economic activity

Referral to secondary care

A major responsibility

(Usually) no place for referral except in consultation with the GP, or in an emergency

Assessing and monitoring response to treatment

Usually the GP’s responsibility (often in conjunction with secondary care)

Occupational health departments may be able to help with routine monitoring of health conditions, especially those with a particular potential impact on work (e.g. hypertension, diabetes, bipolar disease)

‘Routine’ health screening

Integral part of the GP’s role

May have a place in occupational health practice, but health screening is usually targeted at specific areas (see below)

Patient advocacy

The GP often acts as the patient’s advocate, with Government departments, local authorities, social services and other healthcare organisations

The occupational physician aims to remain impartial – not taking sides with patient, employer, trade union, etc. – and therefore usually avoids advocacy

Advising on state benefits

Significant role

Significant role, particularly where disability is affecting earning capacity

Advising on other sources of help and advice

Significant role

Significant role, particularly agencies that can assist in maintaining employment

Advising on fitness for work

A fundamental, if controversial role

Primary function – related to the individual’s usual job and to any alternative jobs

Advising on early retirement due to ill health

May advise a patient to consider early retirement and provide factual information, but usually has no decision-making role

Advises patients on ill health retirement, and often advises pension fund trustees on a patient’s eligibility under the rules of the scheme. Sometimes has to advise pension fund ‘independently’ of the occupational health role for the employer

Health promotion

A fundamental role

A growing role in relation to the ‘healthy workplace’