Disagreement with an occupational health report

Dissatisfaction with health report

Part 1 - When a patient disagrees with information going into an occupational health report.

Background 

Mrs Sullivan has been signed off work by her GP for six weeks with anxiety and depression.

Dr Jackman is an occupational health doctor.  He has been asked to assess and advise on when Mrs Sullivan may be able to return to work and what appropriate adjustments should be made.

Dr Jackman carries out the assessment and emails Mrs Sullivan a copy of his report.

Scenario

Mrs Sullivan telephones to say she’s unhappy with the report because it mentions that she is menopausal and receiving treatment for an underactive thyroid. 

Both conditions were discussed briefly during the assessment, but she doesn’t think they’re relevant to her anxiety and depression which she feels were caused by conditions at work.  She fears that her employers will use the report to dismiss her as ‘a hormonal woman’ and gloss over a hostile work environment. She asks Dr Jackman to remove the references to her menopause and underactive thyroid from the report. 

However Dr Jackman, thinks that these hormonal issues, though not the main cause, may be a contributory factor and are also affecting Mrs Sullivan’s ability to cope. 

What should the doctor do?

  1. Agree to amend the report? 
  2. Refuse to amend the report and explain his duty to Mrs Sullivan’s employer? 
  3. Explain the purpose of asking Mrs Sullivan to review the report and the limited circumstances in which he can amend it? 

What the doctor did

Dr Jackman explains that patients are sent reports to see what they contain, and to check for factual accuracy. 

He explains that inaccuracies can be corrected but relevant information can’t be left out. He tells her that  he believes her hormonal conditions are relevant to her anxiety and depression so he can’t not mention it. 

But he agrees to include more detail about the work stress Mrs Sullivan has described, and how it might be contributing to her illness. 

What the doctor had to consider

  • Doctors must be satisfied that the patient has sufficient information about the scope, purpose and likely consequences of the assessment and disclosure, and the fact that you cannot conceal or withhold relevant information when writing a report for employment, insurance and similar purposes. 
  • Reports should be shared with the patient before the employer so that the patient is forewarned about the content and can identify any factual errors.

Withdrawing consent for report to be disclosed

Part 2 - When a patient refuses to give consent for the occupation health report to be sent to the Employer.

Background 

Dr Jackman makes changes the emphasis of the Occupational Health Report in response to her concerns that her employers may use the information to gloss over a hostile work environment.   He shares the amended Occupational Health  report with Mrs Sullivan ahead of sending it to her employer.

Mrs Sullivan becomes   distressed and tells him that, if he won’t leave out the information about her underactive  thyroid and menopause, she doesn’t want the report to be sent to her employer at all. 

Dr Jackman still has Mrs Sullivan’s earlier written consent.  

What should the doctor do?

  1. Send the amended version of the report to her employer? 
  2. Agree not to send the amended the version of the report to her employer but explain the potential consequences of preventing the report being sent?
  3. Let Mrs Sullivan reword the sections of the report that she is unhappy with? 

What the doctor did

Dr Jackman respects Mrs Sullivan’s wishes but he first checks that she knows that her decision might have adverse consequences for her. 

What the doctor had to consider

  • As with all aspects of treatment and care, having given consent for something, a patient has the right to withdraw consent at a later stage.
  • If a patient withdraws consent for a report to be disclosed, it may be appropriate for the doctor to tell them their decision may have adverse consequences e.g. the absence of occupational health information could disadvantage the patient in negotiations with their employer. The doctor must, however, respect the patient’s final decision unless the disclosure is required by law or can be justified in the public interest. 

Failure to submit report to employer

Part 3 - When there is no occupational report because a patient has disagreed and the employer is asking for details.

Background

Dr Jackman carried out an Occupation Health assessment with Mrs Sullivan.

Mrs Sullivan withdrew her consent for the report to go to her employer. 

Dr Jackman tells Mr Iles, the HR manager that he will not be submitting a report because Mrs Sullivan has withdrawn her consent. 

Scenario 

Mr Iles points out that Dr Jackman has been paid to provide a report and Mrs Sullivan agreed to the assessment. 

Mr Iles says that without the report it will be very difficult to plan for Mrs Sullivan’s absence or manage any potential return to work. He presses Dr Jackman for further information.

What should the doctor do?

  1. Only disclose the reason why Mrs Sullivan has withdrawn her consent?
  2. Disclose the whole report,  Mr Iles has made some fair points?
  3. Not share anything. To share anything further without Mrs Sullivan’s consent would be a breach of confidentiality? 

What the doctor did 

Dr Jackman confirms only that he has spoken to Mrs Sullivan about her decision to withdraw consent and discussed the consequences. 

He tells Mr Iles that he has explained to Mrs Sullivan that  without the report, her employer won’t have all the information they need and might not be able to make informed decisions about her employment. And that he is confident that Mrs Sullivan’s decision was informed and is now respecting that decision. 

He refuses to be drawn in to further discussion.

What the doctor had to consider

  • If a patient withdraws consent for a report to be disclosed, or fails to attend an appointment, you can let the report commissioner know but you should not disclose any further information.