Advertisement

Medicine, Health Care and Philosophy

, Volume 16, Issue 3, pp 499–506 | Cite as

Models of occupational medicine practice: an approach to understanding moral conflict in “dual obligation” doctors

  • Jacques Tamin
Scientific Contribution

Abstract

In the United Kingdom (UK), ethical guidance for doctors assumes a therapeutic setting and a normal doctor–patient relationship. However, doctors with dual obligations may not always operate on the basis of these assumptions in all aspects of their role. In this paper, the situation of UK occupational physicians is described, and a set of models to characterise their different practices is proposed. The interaction between doctor and worker in each of these models is compared with the normal doctor–patient relationship, focusing on the different levels of trust required, the possible power imbalance and the fiduciary obligations that apply. This approach highlights discrepancies between what the UK General Medical Council guidance requires and what is required of a doctor in certain roles or functions. It is suggested that using this modelling approach could also help in clarifying the sources of moral conflict for other doctors with “dual obligations” in their various roles.

Keywords

Occupational medicine models Occupational physician Doctor–patient relationship Dual obligation Moral conflict Fiduciary obligations 

Notes

Acknowledgments

I wish to thank Professor Søren Holm and Dr. Sarah Devaney for helpful comments and suggestions.

Conflict of interest

None.

References

  1. Ballard, J. 2011. OH professional practice, Part 1: Jobs, priorities, concerns, threats and opportunities. Occupational Health [at Work] 8(1): 21–27.Google Scholar
  2. Bartlett, P. 1997. Doctors as fiduciaries: Equitable regulation of the doctor–patient relationship. Medical Law Review 5: 193–224.PubMedCrossRefGoogle Scholar
  3. British Medical Association 2012. Medical ethics today: The BMA’s handbook of ethics and law. 3rd edition. London: Wiley.Google Scholar
  4. Brazier, M., and M. Lobjoit. 1999. Fiduciary relationship: An ethical approach and a legal concept? In HIV and AIDS testing: Screening and confidentiality, ed. R. Bennett, and C.A. Erin, 179–199. Oxford: Oxford University Press.Google Scholar
  5. Brody, H. 1992. The healer’s power. New Haven: Yale University Press.Google Scholar
  6. Centre for Workforce Intelligence. 2011. Medical specialty workforce factsheet: Occupational medicine. http://www.cfwi.org.uk/intelligence/cfwi-medical-factsheets/recommendation-for-occupational-medicine-training-2011.
  7. Devaney, S. 2012. Balancing duties to the court and client: The removal of immunity from suit of expert witnesses. Medical Law Review (forthcoming).Google Scholar
  8. De Zulueta, P. 2007. Truth, trust and the doctor–patient relationship, 1–24. Radcliffe-Oxford: Primary Care Ethics.Google Scholar
  9. Dyer, A.R., and S. Bloch. 1987. Informed consent and the psychiatric patient. Journal of Medical Ethics 13: 12–16.PubMedCrossRefGoogle Scholar
  10. Emanuel, E.J., and L.L. Emanuel. 1992. Four models of the physician-patient relationship. JAMA 267: 2221–2226.PubMedCrossRefGoogle Scholar
  11. FOM. 2006. Guidance on ethics for occupational physicians, 6th ed. London: Royal College of Physicians.Google Scholar
  12. FOM. 2010a. Future directions for the occupational health care in the UK, A strategic overview. http://www.facoccmed.ac.uk/library/docs/pp_natstrat.pdf.
  13. FOM. 2010b. Good occupational medical practice. London: Royal College of Physicians. http://www.facoccmed.ac.uk/library/docs/p_gomp2010.pdf.
  14. FOM, SOM. 2010. Joint statement to FOM & SOM Members, New GMC Guidance on Confidentiality 2009. http://www.som.org.uk.
  15. Gillon, R. 1985. Philosophical medical ethics. Chichester: Wiley.Google Scholar
  16. GMC. 2006. Good medical practice. London.Google Scholar
  17. GMC. 2008. Acting as an expert witness: Supplementary guidance. London.Google Scholar
  18. GMC. 2009a. Confidentiality. London.Google Scholar
  19. GMC. 2009b. Confidentiality: Supplementary guidance. London.Google Scholar
  20. Grubb, A. 1994. The doctor as fiduciary. In Current legal problems, vol. 47 b, ed. M.D.A. Freeman, 311–313. London: University College London.Google Scholar
  21. Holm, S. 2011. Can “giving preference to my patients” be explained as a role related duty in public health care systems? Health Care Analysis 19: 89–97.PubMedCrossRefGoogle Scholar
  22. Kennedy, I. 1996. The fiduciary relationship and its application to doctors and patients. In Wrongs and remedies in the twenty-first century, ed. P. Birks, 111–140. Oxford: Oxford University Press.Google Scholar
  23. Law Commission. 1992. Fiduciary Duties and Regulatory Rules, Consultation Document 124, HMSO.Google Scholar
  24. Munn, F. 2011. Public declares doctors the most trusted professionals. BMA News Review: 2.Google Scholar
  25. O’Neill, O. 2002. A question of trust, the BBC Reith Lectures 2002. Cambridge: Cambridge University Press.Google Scholar
  26. Rogers, W.A., and A.J. Braunack-Mayer. 2009. Practical ethics for general practice, 2nd ed. Oxford: Oxford University Press.Google Scholar
  27. Suff, P. 2007. Welcome to the working week (OH work survey). Occupational Health [at Work] 4(3): 22–28.Google Scholar
  28. Szasz, T.S., and M.H. Hollender. 1956. The basic models of the doctor–patient relationship. AMA Archives of Internal Medicine 97: 585–592.PubMedCrossRefGoogle Scholar
  29. WHO Regional Office for Europe. 2002. Good practice in occupational health services: A contribution to workplace health. http://www.euro.who.int/__data/assets/pdf_file/0007/115486/E77650.pdf.
  30. WONCA EUROPE. (2011). The European definition of general practice/family medicine. Accessed at http://www.woncaeurope.org/.

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.Centre for Social Ethics and Policy, School of LawUniversity of ManchesterManchesterUK

Personalised recommendations