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Duty to Evaluate Fully

While the law has separated the compensation systems for work-related and general medical conditions, human maladies are less accommodating. It is ethically and legally questionable for a physician to ignore a patient's general medical condition while evaluating the symptoms of the work-related condition. For example, assume an otherwise healthy-appearing patient presents with an injured foot. It is tempting to treat the injury without inquiring into the patient's general medical condition. To do so could prove disastrous if the patient is an insulin-dependent diabetic. If the physician does not inquire about potentially complicating conditions such as diabetes, the employer could be liable for the loss of the foot, and the physician could be sued for medical malpractice.

Occupational medicine physicians should evaluate the patient's acute medical problems, even if they do not bear directly on the treatment of the work-related condition. If a patient walks into the physician's office with swollen ankles, blue lips, and respiratory distress, the physician must evaluate the patient's cardiac function. A patient in acute distress must be managed until a proper referral--emergency transport to a hospital or transfer to the care of an appropriate specialist--is made. The patient cannot be left to make arrangements for care if his or her medical condition requires prompt attention. If the patient is referred to an outside physician, the occupational medicine physician should ensure that the patient receives the needed care. When the condition prompting the referral is work related, the occupational medicine physician will retain primary responsibility for coordinating the patient's care.

A common problem is ensuring that all medical tests are fully evaluated. Irrespective of the reason that laboratory tests are ordered or X rays taken, the physician is charged with evaluating all detected pathologies. Even tests taken as baseline indicators must be evaluated before being filed for future reference. In one case, a physician was found liable for not detecting the shadow of a lung tumor in X rays taken to detect spinal injuries. In another case, a physician was successfully sued for not noting an abnormal white blood cell count in a test taken for unrelated purposes. If blood and urine screening tests for substance abuse report other medical information, that information must be evaluated. This can pose a problem if the tests are part of a more general panel whose other results are discarded. Yet not discarding such results can subject the company to liability for violating confidentiality provisions of the ADA.

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