Occupational medicine poses difficult conflicts of interest between
practitioners and employees.
The laws governing the physician–patient relationship are modified in
Occupational medicine practitioners must understand the applicable
state and federal laws.
Occupational medical records in private offices are subject to inspection
by OSHA and labor unions.
Communicable diseases pose special workplace risks.
Occupational medicine is characterized by conflicts between the employee’s
interests and those of the employer. These conflicts arise from the employer’s
obligation to pay for workplace injuries and disabilities, and potential regulatory
sanctions against employers who have disproportionate numbers of OSHA
(Occupational Safety and Health Administration) reportable events. It is to the
employer’s benefit to minimize injuries and to attribute them to off the job
activities or personal illness. Conversely, in today’s marketplace, many
employees have limited or no personal health benefits. This gives the
employee an incentive to claim that personal medical problems are workplace
related so that they must be paid for by the employer.
State and federal law recognizes that the physician–patient relationship is
different in occupational medicine, and that there are situations where
physicians make medical evaluations of patients without forming a legal
physician–patient relationship. Conversely, the law expects occupational
medicine practitioners of all types to be honest with their patients and to
respect their autonomy and their right to consent to, and be informed about,
their medical care.
This section discusses the basic state and federal laws governing occupational
medical practice, special legal problems such as communicable disease control
in the workplace, and occupational medical services in general medical care
settings. Occupational medicine is a recognized medical specialty, and
nonspecialist physicians who are not experts in occupational medicine can
incur substantial legal risks. Unlike most other areas of medical practice,
providers of occupational medical services must comply with very intrusive
federal regulations on access to and retention of medical records, including the
right of OSHA and others to enter the practitioner’s office and go through all
the occupational medical records.