Public Health Law Map - Beta 5 - Medical and Public Health Law Site

will usually involve both the physician and the employer. The physician can describe
the medical limitations on the worker, but without special knowledge (of OSHA
rules, the nature of certain jobs, etc.), he or she cannot decide that a patient can do
the job adequately and safely. When evaluating patients’ ability to return to work, the
environment in which they work must be given careful consideration. A painter with
a broken leg may be able to paint walls while wearing a cast but could not work on
scaffolding high above the ground. Cardiac patients who want to go back to work
may tell their physicians that they sit at a desk or walk around slowly for the entire
workday. What the physician may not know is that the patient works in an area of the
plant with an ambient temperature of 120 degrees. On the other hand, the section
foreman is not likely to be able to judge how much weight a postoperative patient
may lift without danger. These questions should be worked out cooperatively among
the worker, the employer, and the physician.
Physicians should be cautious about accepting the patient’s evaluation of the work
environment. Patients may not know company policies on limited work or the
availability of special positions for temporarily disabled employees. Private
physicians should get their patients’ permission to talk to their supervisors for an
accurate description of the work available for the patient and the environmental
conditions under which the work is to be done. In many cases, the only way to
determine if patients are fit to return to work is to allow them to try, but with
instructions to both the patient and the supervisor to watch for signs of fatigue or
reoccurrence of the medical problem.
The important thing for the physician to remember is that the medical decision is
what limitations the worker has. Statements such as “able to return to work” or “light
duty only” are not appropriate. The physician should provide explicit limitations
such as “no reaching overhead, no lifting greater that ten pounds, and no exposure to
extremes of heat.” With this information, the employer is the one to decide if there is
a job for this worker that fits the restrictions. Ultimately, it is the employer who must
consider the information available and decide whether to allow the employee back in
the workplace.
2. Release from Work Certifications
Employees seeking off-work slips pose more difficult ethical problems. Although
most have legitimate illness, some do not. There are also employees with valid
reasons for missing work, such as caring for a sick child, who seek medical excuses
for missing work because personal illness is the only approved reason for paid
absence from their workplace. Employers argue that unnecessary absences hurt all
employees by reducing the productivity of the company. This can result in reduced
benefits for employees with legitimate medical needs and in lost jobs or even
bankruptcy. Disputes over time off from work are a recurring dilemma in
occupational medical practice: How are physicians to resolve the conflict between
the patient’s interests and the employer’s interests?
This conflict is greatest when the patient sees the physician after recovering from the
611