David P. Gilkey, DC, PhD, CPE, DACBOH
The roles played by doctors of chiropractic in the workplace continue to evolve daily. The fields of occupational health and safety (OHS) offer endless opportunities for diverse services and roles. Today's chiropractic OHS physician may perform a very broad role, from purely administrative to interactive.
Industries are strapped by expensive compliance measures to satisfy health, safety, and labor laws to protect their workers. In 1994, American businesses spend over $2.4 billion to comply with such laws. Compliance costs for OSHA regulations alone rose to over $637 million, or an average of $460/employee (Laws, 1996). However, injury and illness related costs still exceed prevention and compliance by ten-fold.
It's through efficient and effective prevention methods that these investments in health and safety will pay off. Chiropractic OH physicians can be effective and efficient team players, leaders, and catalysts that facilitate and guide cost reductions, improve safety and health for workers, better communication with employers and employees, reduce workplace injury and illness, and ultimately improve the bottom line, a win-win situation! The utility of the chiropractic OHS physician may be manifested through many roles (Plog, 1988; Sweere, 1994; Ladou, 1994; Herrington & Morse, 1995):
- Workplace familiarity is visiting the workplace to observe and become informed regarding the specific jobs, tasks, and workplace environment to formulate opinions on worker health.
- Treatment of occupational injury and illness can be treating, advising, or supervising cost efficient care for injured workers.
- Advising medical management/cost containment in the development of quality medical management programs.
- Pre-employment/pre-placement examination by developing quality prework/preplacement physical screening programs.
- Baseline health determinations that provide data to identify norms, trends, and changes in worker health.
- Return to work examinations that determining fitness levels and capabilities for workers returning after injury.
- Medical monitoring for gathering ongoing data on continuing health status of workers.
- Independent medical examination to answer questions on the causation, nature, duration, treatment, and residuals of work related injury and illness.
- Evaluating work influence to answer questions of the affects of work exposure to comorbid processes.
- Health education and counseling to assist in the learning curve for workers, supervisors, and managers on health topics.
- Rehabilitation programs for developing, performing, or administrating physical rehabilitation of injured workers.
- Specific fitness evaluations to measure the capabilities of workers against the specific demands of real work.
- Fitting the job to the worker is developing a good ergonomics program that recognizes worker capability and limitation.
- Worksite analysis by methods that provide effective identification of workplace hazards.
- Job analysis by methods to understand the physical, emotional, and cognitive demands of the job.
- Medical team leader providing expert interdisciplinary guidance to solve work related health problems.
- Emergency planning through a contingency program for the catastrophic or unforeseen crisis.
- Recordkeeping/records management by the appropriate reporting methods and records retention program.
- Epidemiology through gathering, reporting, analyzing data on worker health, injuries, and illness, and effectiveness of programs.
- Reporting to management by providing valuable expert communication to improve effectiveness, safety, health, and well-being of workers.
- Advisor to the company by communicating on health issues, regulatory trends, risk assessment, risk management, and cost effectiveness.
- Advisor to insurance company by communicating on health, injury and illness trends, prevention programs, and control strategies.
- Patient advocate by providing or administrating quality medical management that meets the needs of the injured worker.
- Evaluate effectiveness of medical programs through gathering and analyzing data on the effectiveness and satisfaction of company health and safety programs, managed care programs, referral programs, and return to work programs.
With diverse training and flexibility, the chiropractic OHS physician can provide many services critical to workplace safety and health. Applying the fundamental principles of multidiscipline problem solving, virtually all challenges can be met. Collaboration with the medical physician (MD), certified occupational health nurse (COHN), certified safety professional (CSP), certified industrial hygienist (CIH), industrial psychologist (PhD), or any other potential team player will enhance the ability to problem solve and bring the prevention paradigm to the workplace.
References
Herington TN, Morse LH (eds.). (1995). Occupational Injuries Evaluation, Management, and Prevention. St. Louis, MO: Mosby.
LaDou J (ed.). National Safety Council. Chicago, IL: NSC.
Laws J (ed.). (1996, January). OSHA Act high cost criticized. Occupational Health and Safety, 12.
Plog BA (ed.). (1988). Fundamentals of Industrial Hygiene. (3rd ed.). National Safety Council. Chicago, IL: NSC.
Sweere JJ. (1994). Role of the chiropractic physician in occupational health. p. 21:1 In Sweere, J. J. (Ed.): Chiropractic Family Practice -- a Clinical Manual. Gaithersburg, MD: Aspen Publications.
David Gilkey, DC, DABCO, DACBOH, FICC Past President, Council on Occupational Health/ACA Secretary, American Chiropractic Board of Occupational Health/ACA
