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The Occupational Medicine Model: An interview with
Dr. Dick Huset, MD, MPH.
When treating an injured worker, the Occupational Medicine Model assumes that:
1) Employers want productive and healthy employees;
2) Employees want and need their job;
3) It is usually in both parties’ interest that proper healing occur while (whenever possible) keeping the injured employee at some level of productivity.In a traditional medical model, a common view is to ‘protect' the injured worker from the workplace. Too often medical providers, lacking a clear understanding of the workplace and of the duties that the employee will return to, discount the value of having an employee heal while remaining productive and at work. Even when providers do not restrict an employee entirely from work, work restrictions are often overly general, using phrases such as, ‘unable to work outside,’ or too specific such as ‘not allowed to use xyz tool.’
The occupational medicine model communicates relevant, functional restrictions to both the employee and employer, who together determine if and how accommodations can be made, such as ‘Avoid vibrating power tools’ or ‘avoid lifting less than x pounds.’
The occupational medicine model also assumes that
4) Healing takes time.Providers know, for example that X injury requires 2 weeks to heal and Y injury requires 6 weeks. If a patient is not making progress within those expectations, it becomes necessary to reassess the patient. More frequent follow-up exams short-circuits things that can slow healing such as ignoring work restrictions, overdoing activities outside of work, missing therapy, not following prescribed exercises or stretches, being sedentary, etc.
If a patient is not making progress, it is sometimes necessary to involve a specialist. Referral networks should tend to be to specialists who are both technically expert as well as supportive of the occupational medicine/return to work model.5) Healing is psychological, social and physical.
The psycho-social-physical link can be instrumental for helping recovery from an injury. Take for example, a common low back strain. Maybe for the first time in her or his life, a worker is in acute pain. Pain makes them apprehensive not only about how they move and rest, but about how they begin to see the future. Will this become a protracted disability? How will I pay my bills if I can’t work? Who will hire me if I lose this job? If sent home to ‘rest’ for a week, by the end of that time of isolation and inactivity (which limits range of motion and can lengthen tissue healing) the patient is often teetering on the brink both emotionally and financially.
Instead, the occupational medicine model motivates the injured worker to stay mobile and active with limitations, being both physically and psychologically therapeutic. Co-workers who surround injured workers communicate their expectation that the injury will heal, providing ‘pats on the back’ for making progress (e.g., “Joe, look at how well you are doing?” “You’re moving better today!” The ability to continue to draw a paycheck means that economics don’t become as much a factor, enabling the worker to focus on their recovery. Even when the patient arrives for follow-up exams or therapy, occupational medicine clinic staff share and reinforce their expectation that the worker is likely to get better and return to work as a fully-contributing person; something we presume most people want.6) Occ Med makes use of the 'teachable moment'
One other assumption of the occupational medicine model assumes that parties will take advantage of the ‘teachable moment.’ Is it really enough to send someone home just with a prescription for meds and rest? The occupational medicine model requires that providers take time to review injury prevention strategies with the patient and sometimes with the employer; strategies that can be applied both during and after the healing process. Failure to take full advantage of this critical opportunity destines the patient to repeat past mistakes.
While under Minnesota law, most employees can choose where they want to be treated for workers-compensation injuries, but given the substantial benefits to both employees and employers, is it time for your workplace to partner with a medical service that operates within the occupational medicine model?