Personal view

Dr Graham’s article for WorkSafeBC (BCMJ 2006;48[1]:36) makes intuitive sense but is not feasible. He recommends that in instances where a patient may have contracted an infectious disease from the workplace, the family physician should, by phone, take a detailed seven-part history to establish causation. This spares the patient from coming to a clinic and making others ill. This is not feasible because of two obstacles: medicolegal risk and the time cost.

Medicolegally, I have a policy not to talk to patients on the phone, as it increases the risk of making an inaccurate diagnosis or underestimating the prognosis. Regarding the time cost, Canadian GPs are already underpaid and, often, not paid at all for many aspects of their necessary daily workload. If WorkSafeBC wants family doctors to engage in telephone assessments, they must be willing to reimburse this service at least in equivalence to an office visit or more so as to offset the medicolegal risk involved with phone assessments. It will be money well spent if their true goal is to prevent the morbidity and cost associated with the spread of occupational infectious diseases.

—Joelle Bradley, MD


The author responds

The article “Recognizing occupational disease” was intended, in part, to show how we establish a claim for workers who contract an infectious disease in the workplace. In the past, this was more difficult because we often had little or no medical information to go on.

I want to clarify: we do not expect the physician to take a detailed seven-part history to establish causation over the phone. But if a patient does call to describe the symptoms of an illness, and is not coming in for a visit, we simply ask that you record the details provided.

The seven criteria outlined in the article are those taken into consideration by WorkSafeBC to help establish an infectious disease claim. The information can come from several sources including the injured worker, the employer, and the physician. Any of the seven criteria you record will simply be further confirmation of a possible work-related connection.

Should we phone you to enquire about any of this information, you will be reimbursed as per 19930 and we will be grateful for the help. Keeping records would also be of considerable assistance to your patient, who will likely be seeking compensation for his or her work absence.

—Don Graham, MD
WorkSafeBC Chief Medical Officer

Joelle Bradley, MD,, Don Graham, MD, CCFP. Personal view. BCMJ, Vol. 48, No. 5, June, 2006, Page(s) 211 - Letters.

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