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Influencing a timely return to work Comcare 2007

Influencing a timely return to work Comcare 2007. Dr David Allen MBBS(Hons), DPH, FAFOEM Occupational Physician Quality Occupational Health. Joseph Joubert: “ Never cut what you can untie.”. Background. Treating doctor’s role – must be understood

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Influencing a timely return to work Comcare 2007

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  1. Influencing a timely return to workComcare 2007 Dr David Allen MBBS(Hons), DPH, FAFOEM Occupational Physician Quality Occupational Health Joseph Joubert: “Never cut what you can untie.”

  2. Background • Treating doctor’s role – must be understood • Communication in return-to-work and upgrade • Injury management – a team approach • Case manager’s role in return-to-work and dealing with barriers • Negotiation is a key element • Applied negotiation and influencing principles

  3. Overview • Planning • Information • Basic negotiation principles • Power • Points of view • Doctors’ concerns • Tips • Preparing for the call • Faxes • Summary • Resources • Questions

  4. Planning Always start with a plan: • Not dependent on superior knowledge • Viable • Adaptable to your style • Effective against any negotiating style • Designed to reach agreement Robert Estabrook: “He who has learned to disagree without being disagreeable has discovered the most valuable secret of a diplomat.”

  5. Information Before talking to the doctor, review: • Medical information • Physiotherapy advice • Insurer advice • Independent medical advice if you have it • Previous negotiation points Decide what information you need from the doctor Buying is cheaper than asking. German Proverb 

  6. Negotiation principles - Ask yourself What do I want? • Assess your expectations – aspiration vs feasibility Where do I start? • Determine an appropriate starting point When do I move? • Devise a constructive concession pattern How do I close? • Arrange the best compromise

  7. Power Definition: “the capability to get someone to produce an intended effect” • Often not your strong point • Your power depends on how much authority and credibility you can muster. • Don’t forget that the treating doctor wields a lot of this • Therefore need to communicate effectively to achieve a good return-to-work outcome

  8. Seeing it from their point of view Some issues in the doctor’s mind: • Is this in the patient’s best interest? • How can I save face and not appear unreasonable? • How long is this going to take and how many more calls will be needed? • Can I trust this person and what is their track record with injured workers? • Is simply a return to work their reason for ringing or.. • What are their interests? • Am I going to get paid for my time?

  9. Dealing with treating doctor’s concerns • Patient’s interests – declare your concern for injured workers well-being; give evidence (if you can) • Dr’s saving face – think from their side, acknowledge their care • Time pressures – prepare in advance a suitable agreed time • Lack of trust in you - prove yourself and demonstrate your commitment • Questioning your motives - reassure • Perception that your interests are reward from your employer – concentrate on how you are acting in the best interests of the injured worker • Remuneration – advise of payment terms in advance

  10. Tips on the negotiation • Try to get them to identify with you in some way • Try to understand the doctor’s motives, values and needs • Be patient – perseverance and perspective • Be flexible if you can • Don’t use threats if you can avoid it • Anchor high • Start by telling them what they want to hear and then express your ideas simply • Strive for a caring attitude regardless of what you think “You're in a much better position to talk with people when they approach you than when you approach them.” Peace Pilgrim 1908-1981, American Peace Activist 

  11. More tips • Use their name • Always begin in a positive, friendly way • Be a good listener • Ensure the doctor feels in charge • Try hard to see things from their point of view • Avoid arguments • Show respect for their opinion and never say “you are wrong” • If you are wrong, admit it quickly and emphatically • Let the doctor do much of the talking Lance Morrow: “Never forget the power of silence, that massively disconcerting pause which goes on and on and may at last induce an opponent to babble and backtrack nervously.”

  12. Preparing for the call • Get to know the receptionist if at all possible • Contact receptionist well before to get best time for call • Advise of fees for their time (and pay on time) • Minimise disruption • Send a fax to confirm including: • Time of planned call • Your policy and commitment • Issues to be covered • Agreement to pay fees • Ensure receptionist has given doctor the fax • Get your information together • Ensure uninterrupted time “Information is a negotiator's greatest weapon.” Victor Kiam 

  13. Sample case – Jack Jones This worker remains certified unfit. Is having physio regularly. You have spoken to the physio. “Good morning Dr Smith. Thank you for taking care of Jack Jones. I appreciate you for taking the time to talk with me. You may have the fax I sent…… Jack is keen to go back at work. His physio has done a great job and tells us that Joe’s lifting tolerance is improving and he should be able to do some work soon. How do you feel he is progressing?” (Open question)

  14. Jack’s case Dr may respond that expects further progress or otherwise. If remaining unfit then: “What can we do to help him rehabilitate?” ……………………….. “We are happy to organise for x to do an assessment for these.” This allows you to take the initiative

  15. Jack’s case “Jack tells me that he can do some limited tasks at work and the physio agrees that it would be helpful for his recovery. We can ensure that he doesn’t do xyz. What else can we do to ensure he is comfortable at work?” Offer independent rehab case manager if Dr seems not to trust you. Try to make it seem like the Dr is driving this process. At stage of closure need to get written agreement. Suggest send a fax as follows. Can offer to drop it off and pick it up if the Dr doesn’t tend to reply to these.

  16. Sample fax LETTERHEAD Dear Dr X Thank you for taking the time to talk to me today about Mr Jones. As agreed the restrictions/duties are as follows: - - - Please send your invoice to…. with claim number……..and I shall ensure prompt payment. Thank you for your cooperation. ________________________________________________________ I agree to the above restrictions/duties Signed: ____________Date:01.10.07 Dr X Please fax back to 999888777

  17. Dealing with barriers • Transport • Pain • Too early • Unsure about safety • Need another investigation beforehand • Need to rest • They cannot cope • Need time to go to treatment • Stone-walling

  18. Points to remember • Gather information • Get to know the receptionist • Advise of the fees and ensure early payment • Talk to the physiotherapist/specialist • Try to see from Dr’s point of view • Be patient • Be flexible if you can • Don’t use threats • Anchor high • Strive for a caring attitude regardless of what you think – never get angry! • Send a fax • Have strategies for dealing with barriers

  19. Resources and references QOH – (02) 98977699 david.allen@qoh.com.au William Ury, “Getting Past No” $24.95 Herb Cohen, “Negotiate This!” $29.95 James Freund “Smart Negotiating” Dale Carnegie “How to Win Friends and Influence People” NSW MAA whiplash guidelines: http://www.maa.nsw.gov.au/injury43whiplash.htm Dept of Health Back Pain Guidelines: http://www.ciap.health.nsw.gov.au/nswtag/publications/guidelines/back_pain_patient.pdf GP Education Program: http://www.answd.com.au/wc/ NHMRC Evidence-based management of acute musculoskeletal pain : http://www.health.gov.au/nhmrc/publications/synopses/cp94syn.htm Medline: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi National Guideline Clearing House: http://www.guideline.gov/

  20. Questions? QOH – (02) 98977699 www.qoh.com.au david.allen@qoh.com.au

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