Managing injured workers: family physicians' experiences.

OBJECTIVE To understand family physicians' experiences in managing patients within the workers' compensation system.

DESIGN Qualitative study using a phenomenologic approach.

SETTING London and surrounding communities in southwestern Ontario.

PARTICIPANTS Family physicians working in community-based and academic practices.

METHOD In-depth interviews conducted between February and May 2001 with a maximum variation sample of 10 family doctors.

MAIN FINDINGS Few participants enjoyed dealing with workers' compensation problems. Despite the generally straightforward nature of most work related to musculoskeletal injuries, management had to take place within the perceived complexities of the return-to-work process. Suspicion, isolation, and frustration characterized experiences with care of persisting, ill-defined, or complex conditions. Challenged by lack of time, participants were wary when dealing with employers and especially concerned about patient confidentiality. Hence, workplace communication seldom extended beyond the use of standard workers' compensation forms. While appreciative of the input of other professionals within the workers' compensation system, family practitioners were suspicious of external influences on clinical decision making. Participants' perceived commitment to patients conflicted with insurer requirements for adherence to guidelines and pathways of care. Even when patient-doctor relationships were challenged by the effects of an injury, participants saw a clear advantage in maintaining these relationships as a base for future care.

CONCLUSION Although family doctors are integral to management of Canadians with work-related injuries, our findings highlight the complexities of that care. Primary occupational health care extended beyond treatment of injuries into domains of intersectoral communication and patient-doctor relationships. Our findings suggest that workers' compensation authorities could benefit from a better understanding of the dynamics of contemporary family practice and particularly of time and cost barriers to workplace liaison. Communicating with employers would be less threatening if there were an explicit organizational strategy designed to allay family practitioners' anxieties about whether direct liaison with employers is inappropriate advocacy, a compromise to confidentiality, or good industrial practice.