AFOEM eBulletin – 16 November 2018

The occupational physician and communication

There is no doubt that communication between a doctor and a patient is crucial to the diagnostic and therapeutic process. Upon this hinges the doctor’s understanding of the problem that has brought the patient to him/her, and the instigation of appropriate therapies, while also keeping the patient well-informed.

For the occupational physician effective communication goes well beyond the traditional doctor/patient interaction, and largely determines the efficacy with which we can practice our specialty. We generally find ourselves in the situation of providing independent opinion on a worker’s health status and work capacity, and not in the treating physician role. Frequently the person being assessed is angry, resentful and resistant (for different reasons). The art of establishing rapport depends on how the occupational physician initiates and maintains communication with the examinee. I personally find a very good neutral ground starting point is to simply ask “How would you prefer me to address you?” It does not compromise the independence of the doctor but communicates a clear message of respect to the examinee. Naturally respectful and unemotional conversation should be maintained throughout the consultation. Since the crux of our diagnostic process is based on obtaining a detailed history, our goal should be to have the examinee in a frame of mind where he/she willingly gives us the history, rather than us taking the history (a subtle difference but one that is important). The way in which the examining occupational physician does this is predicated by the level of reassuring and effective communication in the consultation.

Our specialty encompasses not only the traditional doctor’s role of taking a history, medically examining and interpreting special tests and then communicating with the injured or ill worker in words that they understand, but it extends to a far greater range of recipients of our opinions. Our specialty requires significant interaction with stakeholders such as employers, lawyers, insurers and other 'decision makers' in relation to the injured or ill worker that we have assessed. There may also be rehabilitation providers, treating doctors, claims managers and case managers, supervisors, union officials and others who have involvement with the case with whom the occupational physician must communicate. Occupational physicians may be called upon from time to time to communicate with the public via the media. 

Communication via the medical report written about a particular case must be in a language that is clear, unambiguous, unbiased and understandable by any who are entitled to read that report. While we might relish including such exotic medical terminology such as 'dysdiadochokinesis' in a report, we should really ask what relevance does such wording have when providing an opinion (other than to our medical colleagues)? The same could be said for eponyms. To many readers of our reports (other than medical colleagues) using terms like 'Phalen’s' or 'Lasegues' or 'Dupuytren’s' means nothing. 
Is this merely communicating our medical cleverness rather than meaningful and useful information to the reader(s) of our reports? Of course, it’s fine to use this type of language between medical colleagues.

Our verbal communication in occupational medicine requires us to be linguistically competent, flexible and clear in what we say. Hence if speaking to a worker about the details of the job that they do, we need the vocabulary of that specific occupation in order to interact meaningfully when taking a history or explaining opinions. That vocabulary may well be the same used with supervisors and union officials, but if communicating with a lawyer then a different level of speech and clarity is required. The occupational physician must cultivate a level of communication flexibility that can be pitched at the level appropriate to the receiver of that information. Of course, giving evidence in court is yet another venue in which the occupational physician must communicate (often under duress). The level of language used in this setting to communicate reasoning for opinions expressed demands a level of unemotional and unbiased clarity.

Amongst the many skills an occupational physician needs in order to effectively carry out his/her professional activity, the ability to communicate effectively across the great variety of recipients of our reports and opinions is an essential component and its importance cannot be ignored.

Dr Dwight Dowda
Consultant Occupational Physician

A message from your President

On Saturday, 27 October I attended a workshop on 'Silicosis – update for frontline clinicians and creating the clinical pathway', at the Mater Hospital in Brisbane hosted by The Thoracic Society of Australia and New Zealand (TSANZ) in Queensland.  

While there still remained unanswered questions regarding clinical pathways and management of Accelerated Silicosis at the conclusion of the meeting, the meeting facilitated and gave momentum to a conversation and cooperation between the involved specialties to develop greater clarity around case definition, health screening, health surveillance, the future management of this condition and how to prevent it from occurring in the future.

A number of key Faculty Fellows and trainees presented on the day, including:

  • Dr Graeme Edwards, on the background to the emergent identification of the condition and its prevalence, what has been done to date, and where to from here, with regard to clinical investigation and management.  
  • Professor Malcolm Sim provided an overview of what is needed for an effective health surveillance database and a national disease registry. 
  • Dr Rosemarie Knight presented a case series of affected workers that she had assessed and managed. Her presentation  highlighted the difficulty in knowing how to manage cases in the absence of well-defined clinical flowcharts for investigation, management and communication of risk against a background of increasing awareness of and associated anxiety among workers.
  • Dr Robina McCann reinforced the concept that clinical pathways and management solutions are obtained by working together with our colleagues in other specialties. 

Other presenters included Dr Ryan Hoy, who is a respiratory physician from Melbourne and who provided an overview on the natural history of silicosis and its variants.  

RACP/AFOEM continues to advocate strongly for the establishment of a national respiratory disease registry. A joint brief is being prepared by AFOEM in conjunction with the TSANZ to be presented at the Meeting of the Australian Health Ministers' Advisory Council (AHMAC) Clinical Principal Committee (CPC).

A reminder that as of January 2019 changes to the MyCPD Framework come into effect. The number of continuing professional development categories will be reduced from five to three:

  • Educational activities
  • Reviewing Performance
  • Measuring Outcomes.   

Given the unique range of work in which occupational and environmental physicians (OEP's) are involved, some SA Fellows have started a discussion to explore what activities and pathways can be utilised to assist in meeting the requirement for reviewing performance and measuring outcomes. I encourage similar discussion and input across the regional committees for suggestions on how these requirements can be met.

Dr Michael Baynes has provided a touching memoriam for Dr Kevin Sleigh and I encourage you all to take a moment to read it. It is included within this eBulletin directly following my message. 

HBGWThe Health Benefits of Good Work (HBGW) Signature Steering Group New Zealand presented a successful HBGW Industry Forum at the University of Otago in Wellington on Thursday, 8 November. Professor Anne Harris from Occupation Health at London South Bank University was in New Zealand, courtesy of Dr David Beaumont and Fit for Work and was engaged as Keynote Speaker on ‘the underlying concepts, evidence for and practical application of the Health Benefits of Good Work’. Dr Beaumont presented on ‘Good Work – Make It the Norm’ and explained the link with the successful RACP NZ campaign #MakeItTheNorm. The event had an impressive attendance of over 60 Consensus Signatories and interested parties. An attendee posted on LinkedIn, “A superb event… There were so many ‘take homes’. A quality 4 hours. Thanks.”

As a follow up to Dr Peter Sharman's article in the August edition of the eBulletin 'Occupational Physicians needed Down-Down under', the Tasmanian Regional Committee has taken action and sent an information paper to WorkCover Tasmania. The document outlines the value of an OEP and the negative impact of not having local specialist work doctors, to provide continuity of care, who have an understanding of site specific needs, and who can develop relationships with treating providers, employers and insurers. The paper offers various solutions to address this urgent matter. On behalf of AFOEM, I hope the submission results in a positive response and supportive action.

Cara Loftus left the Faculty on Friday, 19 October 2018 to return to the United States. We are looking forward to welcoming our new AFOEM Executive Officer on Monday, 26 November.  

A final reminder that the South Australian RACP Annual Scientific Meeting is on 1 December for interested AFOEM Fellows. 

Dr Beata M Byok
President AFOEM

Obituary for Dr Kevin Sleigh

Dr Kevin Sleigh died on Thursday, 11 October 2018 aged 67.

I first met Kevin in my early days in occupational medicine. We quickly became aligned as friends and as respected colleagues. As has been noted by others, I felt I had made a friend as well as a respected colleague.

Kevin graduated from Monash University in 1974 and after working in the UK as a locum GP returned to Australia and worked in his general practice in Essendon from 1978 up until 1998. During this time, he had a keen interest in aviation medicine, having at one stage, wanted to be a pilot, and so in 1992 he completed a Certificate in Civil Aviation Medicine and later in 1996 obtained a US certification as a drug Medical Review Officer, being one of the few doctors in Australian to obtain this qualification.

Around this time, he became increasingly interested in occupational medicine and began working as a medical advisor to various companies. He became a Fellow of the Australasian Faculty of Occupational Medicine in 1998.

Kevin continued working as a consultant occupational physician across various industries including Caterpillar, The Herald and Weekly Times, Qantas and Ansett. Kevin also worked as an independent medical examiner and as a medical advisor at WorkSafe.

Kevin was fully committed to The Australian and New Zealand Society of Occupational Medicine (ANZSOM) accepting roles as Honorary Secretary General and President from 1992 to 1994. He was also involved on various committees of the Australasian Faculty of Occupational Medicine as well as being Victorian Regional Censor for many years.

In 2007 Kevin was appointed Senior Clinician on the WorkSafe Clinical Panel and in 2010 as Clinical Lead for all Medical Specialties for both WorkSafe and the TAC.

Kevin and I have had a similar medical career over the years and had a close relationship over the past fifteen years or so. I was able to persuade Kevin into taking over my role as Regional Censor, and amazingly, he continued to talk to me. We set written questions for the Fellowship Exam together and found that individually, our marking of the questions was almost exactly the same.

I will miss our regular 3pm Tuesday coffee and the sharing of a slice of cake, where we would discuss the various issues of the day but invariably ending up talking about occupational health matters.

Kevin’s expertise was highly valued by colleagues and external stakeholders and organisations. His wide breadth of knowledge and expertise and natural ability to communicate allowed him to work collaboratively across the occupational health arena.

Kevin passed away peacefully with his wife Valerie, and children Nicholas and Caroline by his side. He was a dedicated and wise physician who many have enjoyed working with over the years and he will be sorely missed.

Dr Michael Baynes
MBBS MPH ACCAM FAFOEM 

New approach for 2019 Divisional Clinical Examination scoring

A new approach to scoring candidates’ performance in the Divisional Clinical Examinations was approved by the College Education Committee on 2 November 2018. The way that candidates need to prepare for the examination has not changed: candidates still need to demonstrate the same skills and competencies as they have in past years.  The Divisional Clinical Examinations will continue to consist of two long cases and four short cases involving real-patient situations.  

The changes in 2019 will include:

  • a clarified examination purpose, and definitions of the long case and the short case
  • improved scoring guides for examiners that link the purpose of the exam to the candidate scores and guide the application of a new six-point scoring scale
  • a score combination grid to combine each candidate’s scores for the long cases and short cases, determining their overall pass/fail outcome.

Details of the changes for the 2019 Divisional Clinical Examination, scoring guides, videos explaining the new approach, and examples of how the score combination approach works, along with other information, is available on the RACP website’s exam information page.

AFOEM Regional Committee casual vacancies

There are various casual vacancies on AFOEM Regional Committees to be filled by way of expressions of interest.

New South Wales

  • one position open for Trainee Representative of AFOEM NSW Regional Committee.

Queensland/Northern Territory

  • one position open for the Chair of AFOEM QLD/NT Regional Committee
  • one position open for Deputy Chair of AFOEM QLD/NT Regional Committee.

South Australia

  • one position open for Deputy Chair of AFOEM SA Regional Committee. 

Western Australia

  • one position open for Chair of AFOEM WA Regional Committee
  • one position open for AFOEM Trainee Representative of AFOEM WA Regional Committee.

Before nominating for the role, candidates must familiarise themselves with the following documents:

To nominate, submit a completed Expression of Interest Form and your resume by email to AFOEM@racp.edu.au.

RACP Awards and Medals

To acknowledge outstanding achievements of our members, the College grants a number of awards. These awards provide an opportunity for the College and its membership to recognise and celebrate the accomplishments of members as well as promote their successes to inspire others. 

Nominations are now being accepted for the Ramazzini Prize.

Fellows and trainees of AFOEM are encouraged to consider nominating members of the
Faculty for these awards.

Urogynaecological Mesh Senate Inquiry

The Australian Government has tabled its response to the Senate Community Affairs Reference Committee Urogynaecological Mesh Inquiry. A copy of the Government’s response is available on the Department of Health’s website. In addition, the TGA has launched a web hub to help consumers and health professionals find information about urogynaecological surgical mesh.

Time to recharge with up to 60 per cent off at selected hotels 

RACP members have access to the buying power of the world’s largest online travel agency, offering over 100,000 promotional deals and competitive rates on hotel accommodation in more than 71,000 locations worldwide.

No matter your destination or whether it’s for business or leisure, browse through an extensive range of properties, from resorts and villas to executive apartments and five-star luxury suites.

To access this benefit, visit your RACP Member Advantage website or call 1300 853 352. 

Terms and Conditions apply. Savings dependent on availability and location. Information correct as at 7 November 2018.

Expressions of Interest

RACP Fellowship Committee Specialty Society representative opportunity

Check the Expressions of Interest page at any time to find out if there are any opportunities that are of benefit to you.

Career opportunities

New South Wales
Physicians for Private Practice 

View all positions vacant

Find a consultant page on RACP website

Just a reminder to all AFOEM Fellows and trainees, AFOEM is the only Faculty, Chapter or Division that has created a dedicated page on the RACP website that lists contact details for AFOEM Fellows by state. It is an incredible resource that can be used by all members of the Faculty.

The list is located on the find a consultant page on the RACP website. If you are included in the current listing and your details have changed or you would like to be included on the webiste, please email the AFOEM Executive Officer at afoem@racp.edu.au with the details you would like included on the page (name, address, contact number and preferred email address).

This page is also a useful resource for finding contact details for colleagues in your state and for regional committees to reach out to other Fellows that may want to be included in the various state-based activities. 

AFOEM contact details

AFOEM Faculty enquiries (including Council and committees):
AFOEM Executive Officer
Phone: +61 2 8076 6351
Email: afoem@racp.edu.au

AFOEM Education and Training enquiries:
Molly Davies, Education Officer
Phone: +61 2 8247 6268
Email: occenvmed@racp.edu.au

AFOEM Examination enquiries:
Examination Coordinator, Assessment and Selection Unit
Email: examinations@racp.edu.au

AFOEM training site accreditation inquiries:
Site Accreditation Unit
Email: accreditation@racp.edu.au

AFOEM CPD enquiries:
Email: mycpd@racp.edu.au
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