ALF MAGNE HORNELAND
The doctor’s role in medical selection is different from the role in the usual way doctors handle their customers. The below table gives an impression on how different such work is.
Comparison of doctors’ different roles | |||
Seafarer’s doctor | Company doctor | General practitioner | |
Role | Compliance check | Prevention | Treatment |
Focus | Fitness for work / absence of disease | Working environment / Occupational injuries and diseases | Individual’s health |
Perspective | Maximum two years ahead | Past, present and future | (Past), present and future |
Tools | Medical selection in relation to requirements | Environmental factors affecting the worker | Medical treatment of illness and injuries |
Aim | Contribution to the safety of the working environment | Prevent occupational injuries and diseases | Prevent and treat disease regardless of cause |
Acts | Ship Safety and Security Act | Working Environment Act | Health and Care Act |
The individual | A Candidate | An employee/worker | A Patient |
Table 8: The roles of the medical examiner in medical selection, compared to other roles a doctor can have (Horneland AM). | |||
Medical examiners approved by the NMA act as civil servants when carrying out their work as NMA seafarers’ doctors. They are checking whether the seafarer – today – meets the requirements, and assessing whether this is likely to be so for a maximum period of two years ahead. If not, they will limit the time of the medical certificate. The seafarer is a candidate showing up for his compliance check, and the result could be ‘pass’, ‘fail’ or ‘pass with restriction and/or limitation’. This is quite different from the role of a company doctor whose real ‘patient’ is the working environment or a general practitioner who is focusing on the patient’s individual health issues.
To give an example – an individual with a hearing loss, coming to three different doctors.
Seafarer’s doctor: | Company doctor: | General practitioner: |
The AD will · Check the hearing capacity against the requirements Decision · Issue a medical certificate if compliant · Issue a declaration of unfitness if non-compliant | The company doctor will · Check the medical record, to see if there is a trend in hearing loss · Ask if the worker is using hearing protection · Ask if there is much noise at the working place · Ask if there are colleagues that are suffering from hearing loss Decision · Inform about the use of hearing protection · Carry out a noise level measurement at the working place · Call the colleagues for a hearing measurement | The General practitioner will · Check if there is cerumen in the auditory canal · Ask if the patient needs hearing aid · Ask if he want to be referred to a specialist Decision · Refer to specialist if patients want so · Ask the patient to come back if he think the hearing deteriorates |
It is obvious that the approach is very different. However, why is this important?
Sometimes there are legal barriers between what a general practitioner can reveal of information towards others, especially towards people outside the regular health service. This would apply in dealing with civil servants who is carrying out a lawful differential treatment or medical selection of workers. Having both roles, sometimes leads the doctor to trouble. He may not be entitled to know in another role what he knows in one role. Having also a company doctor role for the worker’s company, could lead to double trouble.