Every Job Has Its Problems

As easy and stress free this job has been at the airport, of course it has its own set of problems.

When working for an occupational health clinic there can sometimes be some conflict between providers and the employer. The employer has this clinic to evaluate injured workers so that they can reduce costs by avoiding them from having to go to the ER or urgent care, and to have them be evaluated quickly so they can return to work. The goal is for them to get back to work as quickly as possible!

Thus, it is a big ‘no-no’ to recommend the patient go home without work. For instance, lets say a patient had a back injury from lifting heavy baggage, and shouldn’t continue to lift heavy baggage for the next few days. The employer would rather you provide the patient with work restrictions, including avoiding heavy lifting >10 lbs, walking and standing for up to 1 hour each shift etc. This way, the employee’s supervisor can find an alternative duty for that employee such as desk work or scanning bags etc. Of course they would rather have the patient at work doing something, than going home with partial pay for no work.

This is understandable, but as a nurse practitioner, my patient will always come first. There are times I do send my patients home unable to work. And a case manager from the employer would call me trying to find out why and insist I change my recommendations. These case managers are non-medical so I am rarely influenced by their comments.

Originally I didn’t think it was a big deal to receive their phone calls, but then they started to complain about the minutest things. In a world with so much chaos and injustice, I do not think these complaints are that serious. I would rather not waste 15 minutes of my day discussing these cases with the case managers.

There was one case where a worker twisted her back while moving a 70 lb bag, then accidentally fell and injured her back. She had trouble sitting during the exam but was comfortable with standing and walking. I put her on restrictions, which included no heavy lifting and “no sitting”. The case manager called me to ask why I put “no sitting”, just because the patient could not sit during the visit doesn’t mean I have to advise her NOT to sit. That didn’t make any sense. I kindly said I couldn’t advise someone to do something they are unable to do.

The case manager asked me if I thought the patient had not been sitting this entire time since being seen, like at home. I responded with: I am unsure as I have not seen the patient since the initial visit, but she is coming in tomorrow and I will surely re-evaluate her then. The case manager proceeded to tell me that I don’t seem to have a good understanding of restriction recommendations. I proceeded to tell her that she does not seem to have a good understanding of medical recommendations. She responded that she would escalate the request to the medical director.

My initial thinking was the patient is still able to work with restrictions, she is even able to stand and walk with no problem, which in my opinion is better than sitting for the employer. She was to follow up the next day, so unsure if changing the recommendations was a big deal for 1 day of work? Lastly, the case manager is non-medical so she doesn’t understand that some musculoskeletal injuries cause patients to find their “new” comfortable position. Whether it is sleeping in a sitting position or standing with a side bending position etc.

Too bad the dream job has its own share of headaches.
I do have a new founded respect for the fleet service crew. They often work every day and more than 8 hours per day, doing strenuous activities.


3 thoughts on “Every Job Has Its Problems

  1. Yes! To patient advocacy — one of the things NPs do so well! With ever increasing demands to “get them in and out” faster and faster, we need to remember what our focus is — the patient’s best interest.

  2. “You don’t seem to have a good understanding of restriction recommendations”

    “You don’t seem to have a good understanding of how the medical field works”

    what a jerk, all about the money, never about the people.

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