The Role of Occupational Physicians at the Workplace

The Role of Occupational Physicians at the Workplace
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  87 JMAJ, March/April 2011—Vol. 54, No. 2 Research and Reviews *1Yokohama Complex, Toshiba Corporation, Kanagawa, Japan (as of September 2009) ( article is a revised English version of a paper srcinally published in the Journal of the Japan Medical Association (Vol.138, No.11, 2009,pages 2265–2268). The Role of Occupational Physiciansat Workplace JMAJ 54(2): 87–91, 2011 Nobuyoshi HONDA * 1 Abstract Mental health has been a key issue in Japan’s workplaces, especially since the late 1990s. Firms with more than50 workers are obligated by law to contract a medical doctor licensed in Japan to serve as an occupationalphysician for consultation on health management.A stagnation of the global economy of over a decade brought a drastic change to the workplace environment,which has influenced the mental health of many employees. In particular, major depression is a matter of concerndue to the considerable suicide risk, and occupational physicians are expected to play an important role inthis issue.Detecting and supporting workers suffering from depression in the early stages can save their lives andalso increase corporate productivity. For a corporate organization, it is crucial that an occupational physicianaccumulate professional knowledge, experiences, and theories on the issues of mental health and work motiva-tion improvement and share them with others within the organization.We occupational physicians needs to listen to both the employees and the company, understand eachview, and offer proper advice to both sides. Though it may require years of experience to fulfill such roles, anoccupational physician must have faith in oneself and never give up. Key words Author’s principle, Employee needs, Organization management Introduction The role of occupational physicians in addressing“workers’ depression” is, simply put, risk man-agement with an emphasis on safety. Since themid 1990s, major depression has been the main focus in the workplace mental health education of  Toshiba Corporation (my place of employment). However, in the ever changing industry frontlines, depression has become almost a symbolic termof mental health issues, and the reality of depres-sion is diversifying. Occupational physiciansshould have a sensitivity to detect the intrinsicrisk of depression.In this paper, I discuss the various possibilitieson roles of occupational physicians focusing on my own principle for workplace mental healthcare in general, including depression, the employeeneeds and their accommodation, and initiativesthat should be taken to ensure mental health inthe workplace. My Principle and Employee Needs Principle as occupational physician Adjustment disorders, anxiety disorders, andpersonality disorders that we occupational physi-cians commonly see when managing workplace mental health are outward-looking diseases, which become exposed though problems interactingwith other people; however, depression is aninward-looking illness that builds up internally. 1 As the working environment and interpersonalrelationships change, people are suffering from a  88 JMAJ, March/April 2011—Vol. 54, No. 2Honda N greater variety of mental health problems thanever. But still, anti-depression measures are anyless important.My principle is, “I will protect you under mycare, as long as you want to be dedicated to thecompany and wish to be useful for the company.”I always try to come back to this principle when-ever I am at a loss. Employee needs As far as I have been able to ascertain, employeeneeds and expectations in mental healthcare areas follows: Accessibility of consultation services In-company telephone hotlines and other ser-vices are certainly worthwhile, but some peoplehave said that even picking up a telephone is toomuch in really difficult times. This suggests thatsome people are suffering so badly that even theycannot be helped even with the outsourced tele-phone hotline system (introduced at Toshiba in2000). In this sense, the presence of easily acces-sible on-site occupational physician who canactually be seen in person is important. Hospitality of an occupational physician Occupational physicians should master counsel-ing techniques such as close listening, supportiveresponses, and rephrasing, as well as the processof bringing empathy. Burying one’s face in thepatient’s medical files and showering him / herwith questions without any eye contact will onlyerode the patient’s willingness to consult with aphysician. Middleman to the workplace Sometimes, simply empathizing and providingemotional support to a worker will result in somekind of resolution. But in many cases the inter-ventions in the relevant workplace are preferred.Each workplace’s capacity to make personal andenvironmental adaptations is different, so theoccupational physician’s skill will be tested byhow he / she designs the goal. Psychiatric care is not desired An occupational physician who is also expectedto provide psychiatric treatment will always beambivalent about his / her role as an occupationalphysician. An occupational physician is not apsychiatric healer. It is extremely helpful foran occupational physician to fulfill his / her dutyif the organization has sympathetic understand-ing of this perception, and such understandingcomes from building up daily work and mentalhealth education in the organization. Opinions in the general public Since I joined Toshiba as the occupational physi- cian, people have often told me that they want me to be someone that both rank-and-file workersand managers can consult about any issues, notonly work issues but also everything from trivialeveryday problems to personal concerns. I thinkthat the role of occupational physicians is to facethis kind of simple and honest voice, sincerelyand earnestly. Role of Occupational Physicians inMental Healthcare Secondary prevention of depression(early detection, early intervention) General opinions suggest that, although occu-pational physicians are expected to have a highdegree of personal maturity, people often thinkthat our everyday work simply amounts to “wait-ing” for patients to come in. However, occupa-tional physicians do not simply wait—secondaryprevention (early detection and early interven-tion) requires that we stay one step ahead on adaily basis.Occupational physicians use questionnairesat regular checkups and interviews on availableoccasions to detect those with mental health problems at an early stage. The main focus of sec-ondary prevention is obviously the measures to prevent depression. Toshiba uses electronic ques-tionnaires, and all occupational physicians andhealthcare staff learned the Mini-InternationalNeuropsychiatric Interview (MINI). 2  The indi-vidual face-to-face health support sessions pro-vided to all employees after the checkup aim todetect those with signs of depression, particularlyof major depression, at an early stage. (Thesemeasures were introduced in Toshiba in 2000).Self-care and manager education programsfocus on recognizing the signs of depressions.However, the need to ensure the health andsafety of workers is not easily conveyed. Rather,the stories of individual cases and discussingthem as guideposts for prioritizing often help torealize the obligation to protect health and safetyof oneself and others. How accessible should occupationalphysicians be? Occupational physicians’ work (and the environ-  89 JMAJ, March/April 2011—Vol. 54, No. 2THEROLEOFOCCUPATIONALPHYSICIANSATWORKPLACE ment) involves a long-term relationship withindividual consulters, so we should use time toour advantage.Occupational physicians frequently partici-pate in various meetings and public and privategatherings, and we should enjoy the opportunityto make comments as the only medical profes-sional present. We are often asked to give talks,so we should simply look forward to a chance toshowcase our narrative skills and sense of humorand enjoy the feedback without becoming tootense. Remember, laughter is a catalyst for trust. Luckily, I was given the responsibility of admin-istering my own homepage on the in-company website, which was unusual back in 1996. I earneda reputation for my unfettered posts about myview of society and life, as well as health andmedicine. This had a publicity effect for occupa-tional physician. The needs of the times may havechanged since, but I believe there are ideas andtechniques suited to each period. Empathy is equivalent to imaginative power There is no manual when becoming involved with another person’s life. Instead, we should have anopen mind so that we can respond to any prob-lem we are confronted with firmly and calmly. Work is life itself. A person’s gender, age, family,economic power, academic background, expertise,work history, innate personality, and indelible past lurk behind each issue brought to occupationalphysicians. We cannot jump into making causalconnection, we must just listen for the factorsbehind the concern and sympathize. An imagina-tive power that does not push the speaker, fearsilence or rush to judgment leads to empathy.Nevertheless, occupational physicians do notsimply provide empathy. After all, our missionis to improve the health of the workplace andensure productivity. While offering sympathy,we must consider what we can and cannot do inthe workplace and how the overall situation canbe saved.As regards depression, most consulters feelthat they are responsible for their own tendencytoward negative thought and their problems withinterpersonal relationships. However, instead of  just encouraging the consulter to keep a stiff upper lip, I want to convey the idea that thesenegative feelings are the same basic creativeemotions that induce humans to feel dissatisfiedwith mere safety and tranquil “now.” Occupational physicians belong to catch-allschool of thought If consulters’ problems are clearly based in depres- sion, occupational physicians may recommendtaking a temporary leave of absence. In thissense, occupational physicians must have bothclinical psychiatric knowledge and the ability toprovide correct diagnosis and proper initialtherapy. This is essential not for the purpose of treatment, but for a consulter to meet a goodattending physician, build a good relationship,and receive support to exclusively focus on treat-ment without anxiety.In addition, occupational physicians must bevery well-versed in the country’s policy (regula-tions, guidelines) concerning workplace mentalhealth and relevant company rules, such as laborcontracts, work regulations, rules concerningleaves of absence and work reinstatement (intro-duced by Toshiba in 2003), 3  the disability benefitsystem, leave of absence orders, and humanresource rules. These rules must always be kept inmind because they are basis for the occupationalphysician’s power of persuasion and reliability. Personal view on organizational management —tertiary prevention of depression I wrote about finding the courage to recommenda temporary leave of absence from work in theprevious section, but at the same time I must alsomention the commitment to provide supportwhen he / she returns to work. Tertiary preven-tion of depression (as in providing support inreturning to work and preventing a relapse) isthe collateral for secondary prevention.Support for the reinstatement may includegiving advices on various issues to the supervisorand colleagues, such as ways to assign work, waysof watching over the returned worker, ways toaddress him / her, and ways to convey assess-ments. Such comments from occupational physi-cians can in turn serve as primary preventionmeasures against depression (preventing before-hand) to minimize the chance of having newmental health cases in the workplace. Occupa-tional physicians are also responsible for thiskind of tertiary prevention. Organizational climate that does not createmental health sufferers In interviews during medical checkups of employees who have been working overtime fora long period, I often hear “even if it’s a bit tough,  90 JMAJ, March/April 2011—Vol. 54, No. 2 I’d do it for that boss” or “I can tough it out somemore for these colleagues.” The key issue inworkplace mental health is what situationsenable people to persist through the same levelof difficulty.One common kind of workload stress is theunexpected work problems. Nevertheless, thestress is alleviated when the people senses thatthe problems are more or less within the antici-pated range or foresees that the problems will letup at some point (future conflict management).People can be tenacious when they believe theirwork has corporate, industrial, or global value(significance) (role conflict management). Evenwhen confronted with difficulties, people areinspired when they are struggling together withcolleagues, and a supervisor is monitoring theirefforts with appreciation and approbation andexpresses gratitude and concern about theirhealth. Of course, people make mistakes in theirwork and will be reprimanded by supervisors.But if they sense that they are respected as indi-viduals and feel that it is part of a learning pro-cess, subordinates will give their loyalty and grow(interpersonal conflict management).In particular, a supervisor’s consideration forthe employee’s family and words of gratitude to them are essential for mental health improvement. These insights concerning a positive organiza-tional climate are indispensable to occupationalphysicians. 4 Penetration of the sense of fair management The theory of organizational justice  is a simplerexpression of the tertiary prevention to primaryprevention of depression. 5  The idea of fair man-agement refers to the application of this theory,in which “fair” implies both equality and justice.Information that is effective in maintainingthe organization’s sense of unity should beshared. For example, information transmitted bya supervisor to his / her subordinate who is on abusiness trip will alleviate the employee’s senseof isolation and provide encouragement (infor-mation justice management). Changes in termsof employment, such as transfers and compen-sation, are explained with equal time given toeach employee. Employees are given equalopportunity to voice their opinions (procedural justice management). Subordinates’ individualityis respected and faced straightforwardly (inter-personal justice management).The aforementioned summarizes fair manage-ment. The concept is well organized and easy tounderstand, and has been well received by theaudience in manager education.Previously, conflicts between supervisors andsubordinates have been quelled by the mentor  (from Homer’s Odyssey ), in other words, a bigbrother that naturally occurs in the workplace.This existence has become rare since the collapseof the bubble economy in the early 1990s, and itsvalue has also been obscured. A medical sociolo-gist Aaron Antonovsky stated the importance of a dependable figure like mentor in his researchabout stress resilience. 6  Developing mentors inthe workplace is clearly an important aspect of an organization’s mental health.However, not only can depression have anunfortunate outcome (i.e., suicide), but the wholestory of those suffering from mental health prob-lems is fraught with the risk of lawsuits. The dailyefforts of a company will determine whether itcan demonstrate corporate views (positive orga-nizational climate and fair management) thatmeet the standards of CSR (corporate socialresponsibility). Occupational physicians play alarge role to this end. Objective eye of the occupational healthprofessional The new knowledge and novel definitions of psychiatric medicine are appealing. However,the occupational physician’s role is to give acalm, objective warning so that the workplaceis not swayed by these new concepts. To takethe example of modern depression measuresand reinstatement programs (commonly called“re-work programs” in Japan), each individualcase differs in the causes, environment, and indi-vidual abilities. No matter what the name of the illness, the risk of an unfavorable outcome isalways the same. The royal road to true occupa-tional health is to weave history within a longtimeframe and without exclusion, so that every-one enjoys a positive working life. Instructing self-care A wide range of self-care methods are available to enhance an individual’s stress resilience, includ- ing cognitive therapy, recommendation of a self-affirming outlook, assertion behavior, and sleepscience. For details, please refer to other works. Conclusion My experience as an occupational physician is Honda N
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