Presentation T O2

T O2 (Oral Presentation):
Refusal to treat injured workers: Results from a qualitative study of Australian General Practitioners.

Presented by: Alex Collie

Authors

Collie A1,2, Brijnath B3, Kosny A2, Ruseckaite R1, Mazza D3

  1. Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, Australia
  2. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
  3. Department of General Practice, Monash University, Melbourne, Australia

Abstract

Background

Clinician refusal to treat (RTT) is controversial. Reasons for RTT tend to be based on the clinician’s personal, ethical and moral convictions, and include refusal to perform abortion or refusal to provide invasive or unnecessary treatments at end-of-life. RTT on the basis that patients engage in behaviours that might be harmful to their health is considered inappropriate. This study examines reports of RTT by General Practitioners (GPs) of injured workers claiming workers' compensation in the state of Victoria, Australia.

Methods

The study involved 93 qualitative interviews with GPs, insurance case managers, employers and injured persons. The study was designed to examine barriers and facilitators to return to work (RTW) of injured persons claiming compensation via the state workers' and transport accident compensation systems. Efforts were made to purposively sample all four cohorts in order to capture a diversity of work experience, injury types, time off work, locales, employer size, and work roles. Data were analysed via thematic coding that used inductive and deductive techniques.

Results

RTT was one theme emerging from the study. When asked about the key issues facing injured persons in their recovery and issues encountered when navigating the health system, all four groups mentioned clinician RTT. GPs, physiotherapists, surgeons and psychiatrists were reported by compensation agents, employers, GPs and injured persons to have refused to treat injured persons. Compensation agents and injured persons said such RTT compounded existing injuries and delayed recovery, prolonging time off work. Reasons cited for doctor RTT included the adversarial nature of the compensation system, administrative burden, difficulty communicating with insurers, low remuneration of doctors and the challenge of dealing with complex claims.

Conclusions

In the jurisdiction studied, some clinicians refuse to treat injured persons for systemic and practical reasons. Clinical, moral or ethical reasons for RTT were not raised by participants. This is a highly concerning finding that raises important questions regarding compensation and healthcare system barriers to treatment of injured workers, the impact on recovery of those injured, and limits on access to important social welfare systems.

Schedule Details

Tuesday September 30
10:45 - 12:15 Morning Concurrent Sessions (T O1 - T O12 and Seminar 4)
Session: Healthcare providers’ interventions II
Room B