Better rules on medical leave durations could help doctors resist employers’ undue pressure

 The medical fraternity has called for guidelines on the issuing of medical leave for foreign workers.

In recent months, several doctors have written about the topic in the Singapore Medical Association’s (SMA) monthly newsletter, calling for clearer medical certificate (MC) guidelines and more comprehensive follow-ups.

Among other things, they pointed out that the existing work accident reporting regime and healthcare financing model for workers give employers “undue influence” on doctors in deciding the duration of medi-cal leave for work-related injuries.

Commenting on recent cases of their colleagues being hauled to court for not giving sufficient medical leave, these doctors called for the authorities and the medical industry to “tackle the greater problem at its core”, rather than “simply setting a number as a key performance indicator (KPI)”.

The doctors were referring to the Ministry of Manpower’s (MOM) current rule which requires employers to report workplace accidents if a worker is given medical leave for more than three days.

While such MC guidelines are meant to improve workplace safety and prevent work-related injuries, they may also create incentives for various parties to avoid reporting them, wrote Dr Natarajan Rajaraman from the Saw Swee Hock School of Public Health in the February issue of the newsletter.

The introduction of mandatory employer-purchased medical insurance in 2010 also means that doctors now compete in the open market and are naturally responsive to the payer’s — the employer’s — interests, he said.

In particular, the practice of issuing “light duty” in lieu of MCs is a “glaring loophole” that offers a “creative means to elude reporting”, said Dr Rajaraman.

“This may partly explain Singapore’s reported rate of work-related injuries being impressively below par among countries with similar rates of work-related deaths,” he said.

Over the last few years, the workplace fatality rate has plateaued at around two per 100,000 workers, and the Government hopes to bring the number down to 1.8 by 2018.

MOM’s figures show that last year, the number of major injuries at workplaces — such as crushing, fractures and dislocations — dipped to 594, from 597 in 2015.

Minor injuries, such as slips, trips and falls, climbed from 11,688 cases to 12,354.

Spelling out clear guidelines on MC durations for typical injuries will offer a reference point for doctors to resist undue pressure from employers, without interfering with routine care, said Dr Rajaraman.

In a separate article in the same newsletter, Dr Joanna Chan and Dr Dennis Chia, both emergency medicine senior residents, also pointed out that foreign workers sometimes refuse medical treatment due to misconceptions or their employers’ reluctance to pay for their treatment.

Doctors can play a role in addressing these issues, such as by referring patients whom they suspect are being refused treatment to social workers or non-governmental organisations in the foreign worker circuit, they added.

Mr AKM Mohsin who runs Dibrasham, a space where Bangladeshi workers gather for cultural activities, said some workers may refuse an MC or hospitalisation for fear of being repatriated, or having to foot the medical bills themselves.

He called for a “standardised protocol” between public doctors and “company doctors”, who are private practitioners with whom the firms have corporate plans.

This will ensure not only adequate care for workers, but also prevent workers from abusing the system, said Mr Mohsin.

Bangladeshi construction worker Md Shovo, who was diagnosed with a spine injury several weeks ago, said he was denied rest by his employer and was threatened with repatriation, despite being given an MC for two days.

Mr Shovo, who is due for a follow-up consultation at National University Hospital (NUH) today said: “My boss says he doesn’t like workers taking MCs ... After (my consultation), I know he will say send me back (to Bangladesh).”

Mr Shovo said he has been advised to seek legal help if his employer continues to adopt such an attitude.

However, foreign workers such as Md Mukul Hossain cautioned against tarring every employer with the same brush.

Mr Mukul, a construction worker who volunteers with Transient Workers Count Too and HealthServe, said most injured workers he had come across were given a reasonable time to rest and recover.

“Most people know the regulations now, and MOM is much stricter because of complaints over the years,” he added.

Commenting on the suggestions made in the newsletter, the Singapore Medical Council (SMC) said its latest edition of ethical code and guidelines for medical practitioners states that doctors must not take into consideration extraneous factors such as who pays for the consultation, what benefits the patients may receive or what the employers’ preferences may be.

However, it is difficult to implement MC guidelines, given the wide range of medical conditions and “equally wide range of possible severities for each condition”, said an SMC spokesperson.

“Ultimately, doctors need to exercise their professional judgment and act in patients’ best interests when deciding on what MCs to give to patients,” he said.

Source:
courtesy of TODAY

by KELLY NG

If you have any stories or news that you would like to share with the global online community, please feel free to share it with us by contacting us directly at [email protected]