We have put together information to keep injured or ill persons informed of what to expect.
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All employers play a crucial role in the prevention and management of workplace injuries.
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Information for Psychologists, Occupational Therapists, Nurses, Exercise Physiologists and Doctors.
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Other key stakeholders are also encouraged to provide Information and comments about issues of relevance .
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Nominated Treating Doctor (NTD) issues


It was mentioned in the preceding document  "The First Month After Injury" that the role of the Nominated Treating Doctor (NTD) in the workers compensation system is a crucial one. The medical certificates they provide regarding work status have binding practical and legal implications for the injured worker, treatment providers and the Agent. Most specialist referrals can only be made through the NTD.

 

The skills, knowledge and experience a NTD has in managing a particular injury and in negotiating the system has major implications for all stakeholders. Some of the problems injured workers, treatment providers, and employers report involve inadequate initial and follow up assessments. It is the NTD’s job to assess properly and diagnose accurately. The NTD should identify red flags immediately such as potential serious or life threatening symptoms, but at the same time not over pathologise a relatively minor injury. An experienced NTD will usually get this right.

 

After a month or so most injuries should be resolving. If they are not resolving the NTD should be finding out why. To do this they need the knowledge and skills to be able to identify the factors that may be barriers to progress and treatment. This means that the NTD should also be aware of “yellow flags" including social and psychological barriers. Yellow flags can include an unsupportive workplace or an extreme fear of re-injury by  the worker. The NTD can provide the relevant support or referrals to address these barriers.

 

After one month it is also possible that there is organic pathology that has not been identified and referral for appropriate investigation and specialists needs to be made. Return to work outcomes are affected when the barriers are not identified and / or appropriate actions to address them have not been initiated.

 

 

Poor Communication with the Injured Worker


Feedback to the injured worker is important in alleviating anxiety about symptoms and in reinforcing commitment to strategies being initiated to help them get better and return to work. A doctor who listens to patients concerns and clarifies issues can be helpful in alleviating concerns. Doctors who do not communicate effectively  can create fear in the patient that their injury is more serious than it is. This will reinforce avoidance strategies in the worker which may include hesitation to particpate fully in treatments, to be physically active,  to want to upgrade work hours or even return to work.

Likewise, a doctor who does not identify and address risky behaviours such as excessive medication and drug use to manage pain and symptoms beyond their real injury tolerances, is likely to end up with a patient who has a significant symptom relapse, injury and health complications and ultimately a poor return to work outcome.

 

 

Poor Communication between Stakeholders


If information is not provided to agents, employers and treatment providers who are trying to support a worker to get better or return to work, inappropriate strategies and counterproductive attitudes in communication may result.   Employers who are not given clear guidelines on what duties should or shouldn’t be undertaken may provide work that is beyond the injured workers capacity  that results in re-injury, or at least tension and friction if the worker then refuses to do the task. Agents then may take the stance that the injured worker is malingering and that the doctor is “reinforcing illness behaviour”.

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