Occupational question

[SubzDoc]

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I need someone to tell me if I’m being unfair. I’m covering a doc who will be out of office for some time. One of their pts sent a request for a letter in support of their employment. They included the final sheet of an occupational evaluation from a doctor at the large organization they want to work for. They also included an email from an employment advisor at the same organization. The eval said they are cleared to be employed but can’t safely do one of the tasks associated with the specific job. It doesn’t say whether due to physical or mental limitations or provide any rationale. The pt wants a letter saying they CAN do that task from the treating doctor. I explained that is not something we can do and they sent the message from the advisor saying that if I can write a letter in support of his ability to do said task, then can take that back to occupational medicine and contest it. They also suggested it may, in effect, prevent employment if he can’t get the letter. Part of me wants to push this until my colleague returns, part of me wants to give the advisor and earful. I typically err on the side of crossing small boundaries if it will help with employment (as opposed to long-term disability, eg) but I feel like contradicting an existing opinion from an independent evaluator as a treating psychiatrist is a different beast. Thoughts?

 

[TexasPhysician]

Without knowing more details, this sounds like something an occupational medicine specialist would complete.

 

[SubzDoc]

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Without knowing more details, this sounds like something an occupational medicine specialist would complete.

Absolutely, the best thing to fight fire is fire. Most people aren’t able/willing to go hire their own independent evaluator to fight for an entry level job, however. Which is why I end up doing some of these evals if I can wrap my head around it. I just haven’t been asked to argue against an existing occupational evaluation before.

 

[Bartelby]

This sounds like a fitness for duty evaluation. Particularly without knowing details about the patient and the alleged impairment, you should not opine on it. In addition to their full history I think you would need to know quite a bit including:

-Understanding why their fitness was called into question
-Reviewing employee performance records
-Understanding specific skills that are required for the job
-Reviewing any relevant incident reports
-Finding out directly from the other evaluator why (in their opinion) the person is not fit for duty

It sounds like at present this is a patient you don't know who allegedly can't work for reasons you don't know. Submitting an opinion that they can work based mainly on a request to do so could land you in trouble if knowing some of the above would have changed a reasonable evaluator's opinion.

 

[SubzDoc]

This sounds like a fitness for duty evaluation. Particularly without knowing details about the patient and the alleged impairment, you should not opine on it. In addition to their full history I think you would need to know quite a bit including:

-Understanding why their fitness was called into question
-Reviewing employee performance records
-Understanding specific skills that are required for the job
-Reviewing any relevant incident reports
-Finding out directly from the other evaluator why (in their opinion) the person is not fit for duty

It sounds like at present this is a patient you don't know who allegedly can't work for reasons you don't know. Submitting an opinion that they can work based mainly on a request to do so could land you in trouble if knowing some of the above would have changed a reasonable evaluator's opinion.

Thank you. As I was at the gym mulling this situation it occurred to me to ask for a release for the occupational medicine doc, I suspect that will shut the situation down in fairly short order.

 

[splik]

The pt wants a letter saying they CAN do that task from the treating doctor. I explained that is not something we can do and they sent the message from the advisor saying that if I can write a letter in support of his ability to do said task, then can take that back to occupational medicine and contest it. They also suggested it may, in effect, prevent employment if he can’t get the letter. Part of me wants to push this until my colleague returns, part of me wants to give the advisor and earful. I typically err on the side of crossing small boundaries if it will help with employment (as opposed to long-term disability, eg) but I feel like contradicting an existing opinion from an independent evaluator as a treating psychiatrist is a different beast. Thoughts?

I do FFDEs and even then I don't typically get into whether someone can or can't do specific tasks for employment. That is really not for a physician to assess. As psychiatrists we should only opine on whether they have a mental disorder which would affect their ability to do x. As a treating clinician, you can decide your comfort level on whether to provide documentation to that effect or not.

We can say certain things are "forensic evaluations" but the reality is the most common types of evaluations are not things that could be reasonably done by forensic psychiatrists or psychologists. Most people can't afford to get an attorney and retain a forensic expert. I am happy to fill out paperwork for patients when needed for things like security clearance, ability to safely practice etc.

so I wouldn't usually say someone can or can't do x but I might say whether they have a mental disorder or psychiatric symptoms, or a level of functional impairment etc that could affect their ability to do x. You also want to include the limitations of the evaluation - e.g. "I saw the patient for a 30 minute visit and have reviewed their medical records. No other records were available to me. I reserve the right the modify my opinions should additional information become available" etc.

tl;dr - it is personal comfort whether to opine on employment, but as psychiatrists we should limit ourselves to questions of whether someone has a mental disorder, whether someone is at risk of danger to themselves or others, their functional status, their response and engagement to treatment, prognosis and NOT questions of "clearance" for work or what tasks they can or cannot do with limited exceptions*.

*exceptions might be things like opining on frequent nightshift work for a patient with severe bipolar disorder, or ability to operate heavy machinery for a patient who is very sedated on clozapine etc.

 

[comp1]

Eh, seriously, they're asking you to make an argument against someone who has presumably more experience with this? I feel for the patient, but this is really not fair to you (or your colleague if you decide to punt).

 

[SubzDoc]

Thank you for the responses, which put the situation into focus. I sent the pt a release to speak with the occupational medicine doctor and we will see if they return it. The pt wants to vroom vroom a company vehicle and this is an addiction psychiatry clinic so I can only imagine what the objection might be but we shall see.