Posted by: scottishboomerang | March 8, 2008

Off the Record: Is Occpational Health bad for Public Health?

hellforwomen.jpg

I was thrilled to be offered a new job recently, my first ever paid legal job, with legal NGO somewhere in England. Let’s call it LoveAndJustice Ltd*. The job is one I fit like a glove, and which I can’t wait to get my teeth into. Finally, someone wants to pay me for my legal skills. I was – am – ecstatic about it.

Everything was wonderful until my expensively, legally trained peepers got a shifty at Occupational Health’s Medical Questionnaire. In the UK, the Company Doctor works for an independent Occupational Health company under contract to ones employer. These companies are supposed to advise their clients, employers, on how best to look after the health and safety of their employees. Lately though (and we’re looking at the last 5 years) they have become risk management firms weeding out potential risky employees before they even start work. The Health Questionnaires gone really beyond the scope of occupational health: determining current fitness to do the work. And what they demand is complete, unfettered access to your GP and to your Medical Records. LoveandJustice Ltd had hired Dial-A-Doc Ltd* to do this very work. And while LoveandJustice Ltd is a passionate defender of human rights, Dial-a-Doc perhaps does not share their passion with equal intensity.

Dial-a-Doc’s Medical Questionnaire hardly inspired trust. It is perhaps one of the most virulently intrusive questionnaire I’ve ever seen, with many questions clearly “risk assessment” questions rather than “health” ones. In fact, the questions on it went well beyond the scope of determining my fitness to do legal work with vulnerable groups of people. The usual questions were there about smoking, drinking, eyesight and hearing. But then everything got a lot more personal. Had I ever had a Sexually Transmitted Disease (none of the current political correctness about “Infections”). Did I suffer from heavy periods? What about my family history? Had I ever been refused Life Insurance, a pre-employment medical? Had I ever been treated for anxiety, or depression? Did I feel appreciated at home and at work? Oh, and sign here and here so we can have permanent carte blanche access to your GP and your medical records. I wondered if this form had been sent down to the Mortal Soul department of Hades, with a post-it note from old Screwtape, baring the enthusiastically scrawled words “Learn, chaps!”. The veiled threat was that if I didn’t sign, then the job was no longer mine.

Signing away access to your medical records is something you have to do these days, it seems, to get a job. But essentially this “sign or resign” ultimatum, however veiled, is a form of coercion which exploits the fact that new employees are especially vulnerable and not in a position to fight for their rights, even though the law does protect you to some measure. And of course, you sign away your rights to medical privacy “voluntarily”.

This is of course rather problematic as the pressures of British life, and a lamentable culture of bullying causes more and more people to be treated for stress and anxiety. If anything is wrong with your reproductive system, facilities are in place to prevent stigmatisation on sexual health issues by allowing people to keep their sexual health records separate from the GP, but no such provision exists in the health system for mental health. Arguably, there is far more stigmatisation and discrimination against people with mental health problems in our society than against those with sexual health problems. And that, if the stats are to believed, involves 1 in 4 of population.

Allowing your employer or a firm hired by your employer to access your medical records can be problematic in so many ways. Firstly, few people actually know what’s in their records. I know I don’t. Doctors err, and when those errors are written down in your records, they are there for ever. One recent and tragic case was a teacher. Some twenty years before, a student doctor had written does patient have schizophrenia? in his record. A question. Not even a diagnosis, and certainly with no basis in fact. And there it stayed, with no basis in fact, until the employer, via Occupational Health, was given carte blanche access to the records. The teacher was suspended and the information got out into the public domain via his employers. Having lost his job, and being persecuted in his small community, the strain became too much and he committed suicide.

On top of this, there are the frequent scandals of the loss of sensitive data by government agencies. There are extremely serious social consequences to granting carte blanche direct access to third parties.

There are other public health conerns. Such incidents underscore the need for indirect access only to medical records by a third party. As soon as it becomes generally known that their medical records will be “sullied” if you seek help for a mental health problem, to the extent that it will affect employment, then people will not seek help at all. And that’s when it becomes very bad for public health. This was precisely the situation which resulted in family planning clinics being able to keep their records separate from GPs.

Anyway, I don’t just need this job. I really want it. Nothing for it. I signed.

Most Scots are sarcastic bandits though. I was sorely tempted to answer to the Sexual Transmitted Disease question with a sardonic “Heck, yeah. Riddled with the a virulent strain of Asian galloping clap, I am. But I don’t think sleeping with my clients is part of my job description this time round.” I thought the better of it at the last moment.

But, as I was pondering this at length, while trying to think of ways to keep their grubby paws off my records while at the same time being as gracious and cooperative as possible, the solution occurred to me for people who wanted to keep mental health issues off their lily-white medical records.

See a gynaecologist.

______________________________________________________

*Names changed to ficticious ones.

**No part of this article shall be interpreted as medical or legal advice.

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Responses

  1. An interesting piece of writing – I wonder if matters could be solved this way :

    By signing a declaration that one is currently healthy – has no serious health problems which would affect being functional in the job applied for and that can be checked with one’s GP …..

    I see no reason to deeply trawl peoples med. details but I do see a reason for employers needing to know whether someone can do the job on a regular basis …I do not feel disability sensitive on this at all ( I am disabled) and I am rather worried about the UK Govt take that all disabled people can somehow be equal or equalised up to others – at what expense ? And also there’s partly a weird fascism in disability (and Mental health disability circles) that demands the whole world adjust always to limitations – Why should it completely ? Mind you it leads me onto other thoughts – It might be that being “irregular of effect” still has real social value but needs to be fitted into a new format which is not “work” but “creative contribution”…In fact the new UK Freud IB get em back to work philosophy will fail because of this black and white take on “work” or “benefits” ….

    I recall arguing for higher disregards for disabled people to a Govt Minister so that “benefits” could be used as a way of creating contributions to society without demanding a regularity of effect that for many cannot be maintained …

    Anyway your piece got me thinking — See you around …

  2. Interesting. I think the thing we have to think about here is “equity” rather than “equality”. If you face particular disadvantage because of who or what you are then treating you the “same” as everyone else could actually worsen the inequality. And clearly you cannot treat people “equally” all the time. It isn’t a good idea for anyone if a blind person drives a car or flies a plane. What you CAN do is lessen disadvantage by using equitable strategies: for example, by using “sheltered” employment.

    This however, is completely different from accessing someone’s medical records for the purpose of weeding out undesirable applicants – ie, people who could potential cost the company money, say, because they carry a faulty gene or a family history of heart problems. There is a massive difference between “could” and “will”, and if such things appear on freely accessed medical records it could cripple someone’s chances of employment even though they are perfectly healthy.

    What is even more concerning is the methods employed – the veiled threat of being fired or losing your appointment – if you do not sign away your rights. This is a form of duress or coercion, and should be illegal. It’s a very very short step from an aggressive, intrusive health questionnaire and being forced to undergo further intrusive medicals, and for your entire medical history to be laid bare, to being asked for DNA samples to screen out applicants who might express genes for cancer etc.

    Perhaps its time for a very lively public debate on this?

  3. It’s sad state of affairs though. How unfair to be held to ransom like this.

  4. Nice story about sexual life in our society

  5. Well … not EXACTLY about sexual life… more about civil liberties and privacy laws really… but thank you for your comment.


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