Doctors need to talk to their patients, part 2

Posted by on December 8, 2013 in Articles, Stories

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By Benjamin Wong

In part 1 was the story of two workers who were worried that their medical records did not correctly capture the circumstances surrounding their workplace accidents. In both cases, the doctors didn’t ask the patients how the injury occurred; representatives of the company spoke to the doctors instead. But employers have vested interests. TWC2 has heard of instances when employers told doctors that the accident happened outside the workplace. Such a record would compromise a worker’s right to treatment and compensation under the Work Injury Compensation Act.

Abdur Rashid’s story is the third, and perhaps the most absurd example I came across within just two hours at TWC2’s free meal service. He was injured in February 2013 while doing a construction job.

“I working ah, then working, suddenly, bang!” Abdur Rashid (pic above) describes how he was hit and gestures to his ankle, “Here breaking. Very painful. Blood? No blood. Safety boot very strong. $120 I pay. No break.” The foot wasn’t broken, “but my ankle breaking.”

Abdur Rashid was immediately sent to Mount Alvernia hospital. “Doctor say very serious. He say 100%, your leg cannot, you next time very hard job cannot do.”

“He put the cement on my leg, then about two months.”

I ask Abdur Rashid what happened during the initial visit to the hospital, and if he or a representative of the employer had explained to the doctor what happened.

“Boss talking, I dont know, I never talk anything,” he replies.

Three months later, Abdur Rashid got a shock at a follow-up visit to the doctor. “I seeing doctor, he say, ‘You big injury, you cannot do anything, you car accident.’

“I say ‘What? What car accident?’ Doctor say, ‘your company say car accident’. I tell doctor: ‘Where got car accident, I hit by excavator!’

“Doctor say, ‘You got problem, go MOM!'”

whoosaidwhattodoctor_sendinpanelAbdur Rashid tells me that his company wanted to send him back. Injured, uncompensated and upset, Abdur Rashid thought that was unfair. “Boss no money give, no insurance how can I go?”

In July, Abdur Rashid engaged a lawyer and brought his case to MOM. It should be noted though that engaging a lawyer is not necessary. He was issued a special pass, allowing him to stay on in Singapore to complete his treatment.

“MOM say see how, car accident or excavator accident. . . . [so] who correct?” Abdur Rashid exclaims loudly, his tone filled with frustration.

I ask Abdur Rashid why he did not get testimonies from his fellow workers.

“How can talk? They working company, scared send back. Everybody know I excavator accident. EVERYBODY.”

Now, Abdur Rashid is waiting for his assessment, but is still unsure of the entire outcome. “Many thing now I don’t understand.”

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What reasons do doctors give for not getting the history from a patient?

I sat down with TWC2 Head of Direct Services Debbie Fordyce, who explained the situation in greater depth.

“Whenever injured workers visit a clinic or hospital, the doctor asks ‘How did it happen?’ And often the injured worker can’t answer, either because of language difficulties or because he is unconscious. If a company representative speaks to the doctor on behalf of the worker, it does happen that they explain the accident/injury in a way that it doesn’t look like a work place injury.”

“Why would they do so?” I ask.

She patiently replies: “Well, the employer isn’t required to pay MC wages, pay for treatment or any compensation related to injuries if it is not a workplace injury.”

“So the company has a strong interest,” I piece things together, “in denying workplace injuries, if they can?”

“Yes. If there’s a chance, they might speak in Chinese, or even English perhaps out of earshot of the worker.”

“And the doctors? How do they fit into all of this?” I question curiously. “Surely they would know if something is fishy?”

Debbie pauses for a moment to gather her thoughts, before explaining the significance of the doctor. “What happens is that doctors sometimes assume the employer has the worker’s interest at heart, and the doctors don’t note down who they got the information from. They write it as they heard it without noting who he heard it from.”

She shares that she had the opportunity to speak to some doctors. “I asked them, ‘Why did you accept the story given?’ And the answer is: ‘I had no reason to think the employer didn’t have the worker’s interest.'”

But why do doctors speak in a language the worker does not understand? Says Debbie,  “The answer [the doctors give me] is that it is easier because the employer is there, and the employer is able to provide more details.”

This can a big problem when injured workers try to claim compensation, payment or obtain a Letter of Guarantee (to cover the cost of follow-up treatment. Explains Debbie: “MOM sends a note to the doctor asking ‘How did the injury take place?’  The doctor’s first report is very important in substantiating any claims or resolving conflicts.”

Clearly, the doctor’s role is critical, and the decisions and details written down carry significant implications. “Once it goes into the medical records, the source is lost,” because doctors don’t have a habit of recording exactly who was speaking at the time, “and it’s hard for the worker to challenge it later on.”

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How can we do things better?

TWC2 recommends having interpreters on hand, at least at those hospitals frequented by injured workers. Doctors could also confirm the information with the patient, and there are several occasions the doctor can do this. To be sure, some injured workers falsify and exaggerate their own injuries or how it happened. But the doctor has the ability to assess if there is a conflict in the stories given to him, and he could note “the worker claims this, the supervisor claims such and such” — he need not make a judgement if unsure. The doctor could also make a notation whether the injury is consistent with the story given.

Besides these practical suggestions, a deeper issue regarding existing mindsets and attitudes towards migrant workers needs to be addressed as well. Debbie elaborates on the inherent difficulties in resolving conflicts, “When the employer introduces element of doubt into how the injury happened, MOM takes the doubt seriously; employer suspicion is given a higher importance than the worker’s story. An uncertainty should not trump the workers story.”

GO TO PART part1_red part2_light

See also Who said what to the doctor?

 

 

TWC2 is an organization that is dedicated to assisting low-wage migrant workers when they are in difficulty. We are motivated by a sense of fairness and humanity, though our caseload often exceeds our
means.

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