• Paul McGovern

Why an occupational health appointment can be like having a doctor in the family

Even though I do say so myself, I cook a great steak. Maybe one day I’ll sell all my secrets, but here’s a top tip for free – don’t use a non-stick pan, and get it really hot before you whack the steak in.

So it was that I was boasting to some friends about how brilliant a cook I was when I burned my hand. We were in an AirBnB in Norfolk and I was banging on about how transcendent the meal they were about to enjoy would be, while dutifully heating my pan and boiling some veg. I grabbed the pan handle (which unlike mine at home was uninsulated), and discovered the hard way that I was even better at heating pans up than my bragging would imply.

I can’t remember if I felt the pain first or heard the sizzle, but after a lot of hopping, howling, cursing and rushing to get my hand in ice water, at least I had an excuse for the mediocre beef I eventually served.

It was agonizing. I could make it just about bearable with a load of ice, but as soon as the burns were exposed to the air things became unbearably painful. Having worked in plastic surgery years before, I knew that severe hand burns warranted immediate referral to a specialist burns unit, and I started to panic a bit, fearing I’d have to go to hospital, have surgery, that I’d never play the guitar again. I did what any clinician does – WhatsApped some doctor mates.

They weren’t specialists in burns, but reminded me that the pain meant it wasn’t a full-thickness burn (very bad burns don’t hurt as all the nerve endings are too damaged). In my agitation I had completely forgotten this, despite having treated dozens of people with far worse hand burns than mine. Although I was reassured, my friends quickly put me in touch with a plastic surgeon they knew who looked at the pictures I sent over and immediately told me it would be fine. After that, everything was fine. It hurt a lot that night, was a bit better a day later, and sorted itself out not too long after that.

This informal network is a big benefit for anyone who either is a clinician or knows a clinician. For my part, if a family member goes to hospital with heart problems, I’ll get a call. If a friend’s kid’s hair starts falling out, I’ll get asked about who the best dermatologist is to see.

When people call me to ask for help, they are generally asking for medical advice. Although I can sometimes give it, I rarely do. I’m far more useful in helping them navigate the system. The way services in the NHS work is often complicated, and understanding how they interface with each other can be tricky. Everyone knows there are waiting times, but with experience of the system you get a feel for when a delay stops being about a big queue and starts being about someone forgetting to put you in the queue in the first place.

Lost emails, secretaries on holiday, doctors pretending they know the answer when they don’t, people getting fobbed off for some reason or another – I’ve helped friends and family through dealing with these issues and more, and helped them along their way in getting the care they needed. This is nothing even remotely special. All clinicians do this.

Of course, it’s not fair and it’s not right that people with access to expert help through connections get better treatment, or learn to navigate the service better. The service should provide high levels of care to all. But what should happen isn’t always reflected in reality; systems will always be imperfect and some people will be luckier than others. The systemic changes needed to stop an expert helping hand being necessary are a bigger topic than I can cover in this post.

How occupational health can help

There are some unique things about occupational health consultations that set them apart from other clinical encounters. First, occupational clinicians give their advice based on a deep understanding not only of their patients’ health problems, but how health, work and their personal lives interface with each other. Appointments are longer, and this gives the opportunity to understand people better. This is a truly holistic approach and it’s inherent to a good occupational consultation.

Second, the occupational clinician is there to offer independent advice and to make recommendations. This independence is critical – we are not part of the patient’s treating team, just as when my relative gets sick I’m not part of their treating team. We offer a different perspective. This perspective is largely not informed by scans, test results, and jargon-filled letters from specialists in the field (although they of course have their place). We give advice based on what the patient themself understands about their health, and based on our own experience of health and healthcare.

The combination of a different frame of reference and a broad understanding of the patient’s health concerns, in the context of their lives, offers some powerful opportunities to help improve things. This can work for people with multiple health problems who are treated by multiple specialists and feel stuck between them all. Occupational health can help with how to manage all those specialists and the systems they work in, helping patients regain a sense of control over their own health. It can also work for seemingly simple things – I have enough experience of tests in the NHS to know that results should have been back by now, and the patient really should chase the hospital to try to move things along.

Most care from the NHS is excellent, but systems fail and people make mistakes. An occupational clinician is no more or less prone to mistakes than others. But as part of the healthcare system, occupational health sits slightly outside the norm. It treats health in a different way, in the context of the patient’s life and environment and context and family. And when health problems seem intractable, sometimes looking at them with a different perspective can empower patients to find new approaches to improve their health for themselves.

The perspective my medical friends offered to me when I was hopping around a cottage in Norfolk turned my fear into something I could deal with. The pain was no easier for a night, but seeing a way through was all the balm I could ask for. The fact we can offer this type of support to people outside our own family and friends is one of the huge privileges of working in occupational medicine and is a significant benefit for many people referred to occupational health.

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