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Competency 4 – Maintaining relationship with patients:Maintain an independent position

Objective: to ensure the appreciation of the professional position of the OH advisor, employer and employees



The dual responsibility of an occupational health doctor requires them to be explicit in outlining their roles and responsibilities within an organisation. The occupational health doctor is an independent professional advisor, concerned with the health of the employees providing advice or opinions that are honest, based as far as possible on fact, and not on prejudice, financial inducement or the wishes of a third party.

This can be highlighted and reinforced by means of the following exercises:

Exercise 1

  1. You have been asked as an occupational health doctor to provide an opinion on a potential employee for the position of a forklift driver in a small company (20 employees) that produces windscreen wipers. During the examination you note that the individual is colour blind. Discuss the following:

Question 1

  • What is the role of the occupational health doctor in this particular situation? (detailed information can be obtained from Guidance on Ethics for Occupational Physicians – Fitness for Work)


  • In pre-employment health assessment the main responsibility of the occupational health doctor is to the employer.
  • To ensure that the potential employee understands the purpose, context and potential outcome of such a consultation.
  • To make an adequate assessment of the potential employee’s health, this is based on a clinical and occupational history as well as physical examination and an understanding of the proposed work. In this particular case the object is to ensure the individual is able to carry out the duties of a forklift driver without any safety risk to themselves or others. Hence clarification on the precise nature of the colour blindness would be necessary, as well as an understanding of the importance of this to the role of the forklift driver.

Question 2

  • How can this role be made clear to the individual?


    • By stating the purpose and context of the consultation at the outset.
    • By informing the potential employee on the outcome of the consultation.

Question 3

  • What can the occupational health doctor state to the employee and prospective employee?


    • To the employer, the occupational health doctor can provide: Information relating to the fitness assessment: i.e. fit for the role, not fit for the role or fit with restrictions for the role applied for.
    • To the prospective employee, the occupational health doctor can outline the concerns raised in relation to the work applied for, with a clear explanation as to the doctor’s opinion and advice. So in this example, the need to be able to differentiate colours may be a safety requirement and the occupational health doctor will need to inform the employer that the prospective employee is unfit to carry out safety critical work that is colour dependant.

Exercise 2

As an occupational health doctor you have been asked to see an employee who has been absent from work for 3 weeks with back pain. The individual works as a receptionist in medium size (50 employees) company.

Question 1

  • What is the role of the occupational health doctor (OHD) in this situation?


    • To provide independent advice regarding the employee’s state of health and fitness for work.
    • The OHD has a dual responsibility to both the employer and employee – necessitates objectivity and impartial evidence-based medical advice.

Question 2

  • What are the possible expectations of the employer/employee?


The Employer:

  1. May consider the occupational health doctor like his GP and expect the same therapeutic relationship with him or her.
  2. May consider the occupational health doctor as an advocate for the employer with no duty of confidentiality to the employee.

The Employee:

  1. May believe that the occupational health doctor was able to fully inform the employer on all clinical information relating to employees.
  2. May perceive an occupational health doctor as part of the management team and was used as tool by management in sickness absence management

Question 3

How can the role of the occupational health doctor be made clear to the employer and employee?


    • By eliciting expectations from both parties at the outset of any conversation.
    • By requesting the employer to provide written referrals to occupational health doctor. This will help identify any misconceptions relating to their expectations.
    • By outlining the purpose and context of the consultation to the employee at the outset.
    • By informing the employee about what the employer will be informed of both at the beginning and end of the consultation.
    • By offering a copy of any written information to the employee and employer.