When occupational physicians have to make difficult calls related to health and safety in the workplace, they shouldn't be loyal to either workers or employers because it could influence their behaviour or cloud their judgments.
“Because impartiality, integrity, trustworthiness and professional autonomy are required from occupational physicians, they shouldn't show loyalty to either employers or employees," says Sasolburg-based occupational medicine consultant Dr Gerhard Grobler who received his doctorate in Applied Ethics at the ninth ceremony of Stellenbosch University's December graduation on Friday (13 December 2019).
In his study, the first of its kind in South Africa, Grobler did a moral analysis of the apparent conflict of interest in the profession of occupational physicians. He says dual loyalty, or at least the suspicion that loyalty to either party would colour the occupational physician's judgement, has been a problem in recent times and creates ethical ambiguity. It's especially when workers are injured on the job that the issue of dual loyalty arises.
Grobler, who has 38 years of hands-on experience in occupational medicine, points out that companies or organisations employ occupational physicians to look after the health and safety of workers who are vulnerable to unemployment, regular retrenchments, poor and collapsing public healthcare, non-compliance with health and safety legislation in the huge informal sector and the inefficiency in the office of the Compensation Commissioner.
“Occupational physicians play an important role in ensuring that workers are not denied healthcare, compensation or related benefits for which they are eligible. It often takes staunch personal commitment of the leaders in occupational health to prevent individual cases from falling through the proverbial cracks.
“Their judgements must be based on scientific knowledge and technical competence and they must not do anything that compromises their integrity and impartiality. They can never allow any conflict of interest to influence their advice and verdicts.
“Occupational physicians cannot serve any masters. Their guiding principle is to serve the health and safety of all workers and that of everyone at risk of illness or injury related to the incapacity of workers – whether the latter are airline pilots, rock drill operators or abattoir staff."
Grobler adds that occupational physicians are medical doctors that workers, employers, labour unions, relevant authorities and society need to believe they can trust with stewardship of the health and safety of workers.
He says where professional autonomy, impartiality, fairness, veracity and sound judgment are vital virtues, loyalty could well be an obstacle because it invites stakeholders to attempt to change rulings made by an occupational physician.
“Employers understandably suspect that their occupational physician is dedicated to the interests of patients. Workers, on the other hand, quite comprehensibly expect the occupational physician, employed and paid by the company, to serve the employer's business interests.
“If workers or employers experience or suspect that an occupational physician identifies with one party or allows loyalty to influence his judgement, all of his decisions become questionable."
According to Grobler, there's not enough appreciation for the role and contribution of occupational physicians in South Africa, especially among doctors in private practice.
“The discipline is often disparaged by some doctors in private practice. The sentiment is 'why would a bright doctor choose to earn a salary by working for a boss in a factory environment?'. And 'why do they seem to side with the employer – who my patients tell me is unsympathetic and unfair?'. "
Having worked closely with many occupational physicians, occupational health nursing professionals and occupational safety professionals, Grobler says he understands their sentiments, as well as the difficulties they face and have to overcome.
“Hopefully, my study might stimulate awareness and reform regarding the ethical challenges in occupational health, especially given the perception that the discipline just protects the interests of big business."
Grobler adds that doctors in occupational medicine, less experienced occupational physicians, non-medical professionals in occupational health and safety, as well as academics who teach ethics in occupational health could benefit from his research.
- Photo: Dr Gerhard Grobler at the graduation ceremony. Photographer: Stefan Els
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Dr Gerhard Grobler
Occupational Medicine Consultant
Cell: 083 6254085
Tel: 021 808 4921