1. 1 Primary Care Today Conference, May 6-8, 2004 Disabilities Management – Work & Health, Health and Work Presented by: Dr. Lisa Doupe MD DIH DOHS Funded by Skills Development Canada, Ontario Region in cooperation with the Ontario Medical Foundation A Work in Progress

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3. 3 Objectives: 1.The Framework for Disability Management 2.Our roles as physicians in the RTF/RTW system. 3.Disability-related forms

4. 4 ADD Definition PAST: Medical model Impairment perspective Social Model perspective Environment NOW: BIO – PSYSCO-SOCIAL MODEL See Defining Disability: A Complex Issue at http://www.hrsdc.gc.ca/en/hip/odi/documents/Definitions/Definiti ons.pdf

5. 5 Present System Complex & Incoherent

6. 6 The causes of work disability Disability = multifactorial problem Workplace WCB/insurerHealth care system Worker Interactions between stakeholders in the disability problem (Loisel et al, 2001)

7. 7 OMA Position POSITION IN SUPPORT OF TIMELY RETURN TO WORK PROGRAMS & THE ROLE OF THE PRIMARY CARE PHYSICIAN March 1994 1. When the patient is off work due to sickness or injury, he/she would bring an employer's proposed return to work program to his/her physician. 2. Physician provides objective reports on impairment, medical restrictions, and other supporting advice to the employee. 3.Employer offers the employee a plan for returning to suitable work in a timely fashion. 4.Employee and management have a primary responsibility to initiate a timely return to work which incorporates input from the physician. 5.Management control of "sick leave" abuse is through work place "culture"" and timely return to work programs, not medical certification.

8. 8 “Injury/Illness and Return to Work/Function: A Practical Guide for Physicians”, PEPWH “ As a physician, treating an injured/ill worker/patient, your role is to promote, preserve and protect the health of the worker/patient, To act as an advocate for policies to benefit his or her health.”

9. 9 Physicians’ Role in Return to Function, Return to Work 8 Steps 1. Assess 2.Diagnose 3.Treat 4.Support a return to work/function plan 5.Monitor 6.Report 7.Communicate GETAN OMA LINK -- http://www.wsib.on.ca/wsib/wsibsite.nsf/LookupFiles/DownloadableFilePhysiciansRTWGuide/$File/RTWGP.pdf

10. 10 Occupational Medicine A preventive medical discipline that deals clinically and administratively with the health care needs of workers individually and in groups with respect to their working environment, and involves the recognition, evaluation, control, management, prevention and rehabilitation of occupationally related diseases and injuries. Reference L. Cheung, MD FRCP

11. 11 Basic sciences central to occupational and environmental medicine Toxicology Epidemiology Biostatistics Occupational hygiene Ergonomics Science of accident prevention Reference L. Cheung, MD FRCP

12. 12 Clinical Competencies Expertise in taking occupational and environmental history Familiarity with the diagnostic procedures essential to the evaluation of occupationally related diseases and injuries Knowledge of assessing workplace and environmental exposures and hazards Knowledge of management and rehabilitation of occupational and environmental diseases and injuries in workers. Reference L. Cheung, MD FRCP

13. 13 Knowledge of Workplace Exposures Recognition, evaluation, control and management of the following exposures: - chemical - biological - physical - psychological stress Requires knowledge of toxicology and occupational hygiene Reference L. Cheung, MD FRCP

14. 14 Professional Organizations in Occupational and Environmental Medicine The OMA Section on Occupational and Environmental Medicine http://oma.org The OMA Committee on Work and Health Occupational and Environmental Medical Association of Canada (OEMAC) http://www.oemac.org/ Ontario Component Society of American College of Occupational and Environmental Medicine (ACOEM) http://www.acoem.org/

15. 15 1. Assess –W-H-A-C-S What do you do? How do you do it? Are you concerned about any of your exposures on and off the job? Co-workers or others exposed? (How) satisfied are you with your job? (Or: How stressful is your job?)

16. 16 Diagnosis and treatment ---- TOOLS Depression and Anxiety HAM –D Tool Kit from Wyeth/ Ayerst Shoulder and upper limb problems –http://www.dash.iwh.on.ca/http://www.dash.iwh.on.ca/ Back Problems - http://www.backguide.com/http://www.backguide.com/

17. 17 Forms Sickness certificates Return to work forms Short and long term disability forms

18. 18 A Business Perspective: From Ability to Disability At work High productivity Average productivity Presenteeism Causal absence Short term disability Long- term disability Canada Pension Plan Disability Off work

19. 19 Consent, confidentiality & liability Sickness certificates –Patient must give consent for information to be shared with employers or insurance companies (Ontario Health Information Protection Act) –Physician opinions = expert = liability –Reference CMA, CMPA, Manitoba College of Physicians and Surgeons –OMA now developing a guide

20. 20 New ACOEM guidelines http://www.opot.org/guidelines/anxiety.pdf http://www.gacguidelines.ca/ http://healthnet.umassmed.edu/mhealth/HAMD.pdf

21. 21 Return to Work Forms Physician provides functional information Employer determines return to work date By law, employee must cooperate (see WSIB)

22. 22 Key Insurance & Benefit Forms Insurance Bureau of Canada Canadian Health and Life Insurance Workers’ Safety and Insurance Board Canada Pension Plan Ontario Disability Support Program Ontario Works

23. 23 Summary Disability is very complex Disability is not disease Physicians have a key role in return to function/return to work Stakeholders have a key role in preventing disability Solutions are a work in progress

24. 24 Thanks To all the partners and stakeholders of the Round Table on Safe and Timely Return to Function/Return to Work To the Physicians Education Project on Work and Health To my staff