EAP with the Doctor Next Door – How to Optimize the

Relationship

Health and Performance Solutions University within the Employer Solutions Division of

ValueOptions

July 12, 2007

Vice Chair of the Division of Preventive and Occupational Medicine at Mayo Clinic, Rochester, MN

Medical Director, Mayo Clinic EmbodyHealth programs

Philip Hagen, M.D., Mayo Clinic

Robin Molella, M.D., Mayo Clinic

Division of Preventive, Occupational and Aerospace Medicine at Mayo Clinic, Rochester, MN

Key contributor to the health management programs and health promotion campaigns

Mark Hyde, M.A., Mayo Clinic

CEAP-certified EAP program supervisor,

Division of Preventive and Occupational Medicine

EAP professional for 15 years Consults with Mayo and other

organizations on employee productivity, satisfaction, and employee change initiatives

1) Recognize the value of a well defined relationship between EAP providers and physicians.

2) Understand the confidentiality issues affecting communications.

3) Be able to list three common triggers that would generate consultation between EAP and MD.

4) Be able to structure effective communication.

5) Be able to list 4 medical conditions which masquerade as behavioral and or performance problems.

6) Understand the resources your MD is able to utilize to clarify behavioral or work performance issues.

Learning Objectives

The Mayo Model How EAP functions in the

medical center Differences from being external

Mayo Clinic Model

Hidden Medical Conditions

Medical masquerades unmaskedTriggers

Introductory case studies

Hidden Medical Conditions

Medical Masquerades unmasked– Dementia– Cancer– Infection– Diabetes– MS

Triggers – sudden changes in performance or behavior

48 Year Old RN

Occasionally acting unusual in the workplace May use foul language in appropriately

48 Year Old RN

Has type one diabetes for 30 years No longer able to sense when her sugar is low Changed jobs to allow more flexibility in testing

sugars

35 Year Old Janitor

New hire who was a “good worker” but couldn’t perform event set up

Saw EAP who wondered about a learning disorder Saw employee health, got tested. Did have a

learning disorder EAP and medical participated in an

accommodation meeting. Now a star employee

Establish the EAP Physician Relationship

Benefits/Power of the relationshipJob site consultation

Communication

Benefits/Power of the Relationship

Workplace Diagnostics

1. Performance

2. Attendance

3. Behavior and satisfaction

EAP Job Site Consultation

Culture History Leadership Recent changes Sociology workplace dynamics

EAP Communication

3-way communication, workplace, provider and client

Consultation services to all parties. Eap most appropriate back to workplace.

Barriers to Communication

ConfidentialityLack of integration

Concerns about over “medicalizing”

Confidentiality and Privacy

Respecting the wishes of the patient/client is paramount. Relationships between EAP and Occupational medicine are complex and dependent on issues such as:– EAP confidentiality practices– HIPAA compliance– Level of integration between providers and also

with the workplace.

HIPAA

…Permitted Uses and Disclosures. A covered entity is permitted, but not required, to use and disclose protected health information, without an individual’s authorization, for the following purposes or situations: … (2) Treatment, Payment, and Health Care Operations; ……

“Medicalizing” Behavior

Deciding when bad behavior is a medical issue can be a difficult process

Fears of treating these “character” issues as medical issues can prevent early consultation

“Medicalizing” Behavior

Doctors answer the questions they get asked When obtaining medical consults ask focused

questions– Rather than the question is this patient depressed?

Does this patient have a medical reason they can’t get to work on time?

Lack of Provider Integration

Many employees have EAP providers and occupational medicine providers and primary health care providers who are in different systems and who are not used to working in an integrated fashion

Many providers do not understand EAP and what services may be provided

Solutions

Relationship with occupational providers

Referral forms

Develop Relationship with Occupational Providers

Proposed Referral Form

Incorporating authorization within the referral form Address HIPAA

Medical Issues vs. Job Fit

Consequences of Chronic Poor Job Fit

Final common pathway in unfortunate employment circumstances is often depression and anxiety

Solving* this dilemma requires a multidisciplinary approach

*solving implies an outcome with productive employee, minimal missed work, minimal medical costs.

Is there a Medical Issue?

Employee presents with physical symptoms or emotional symptoms sufficient to warrant diagnosis

Alleges that her work (co-workers, supervisor etc.) has led to these problems, or the problems at work prevent returning there

“My job made me sick”

– Ask the Medical provider to focus on the medical facts• What is the diagnosis?

• What is the treatment plan?

• What tasks can the patient currently perform?

• Are there medical issues which would prevent the employee from returning to prior work tasks?

– Provide the medical provider with collateral information when possible (specific feed back about performance issues or concerns from supervisor)

– EAP takes the lead on addressing legitimate complaints about work conditions

Common Pitfalls in Navigating These Cases

Being inflexible in modifying “minimum time in job” rules before allowing transfer

Not managing behavioral or “character” issues up front and aggressively

“Medicalizing” Job fit issues Best resource in dealing with this is communication

Best Case

Intervene in “job fit” issues early Focus on job fit as a human capital issue Address medical questions as concretely as possible

Case: 56 year old New Mayo employee

Hired after completion of transcriptionist training Unable after several weeks to maintain the error free rate

required Referred by supervisor with a question can she hear

adequately

Outcomes

Hearing test normal

EAP for support

Supervisor found alternate job for this individual in the work area she handles customer service calls doing corrections.

A “good” employee in a bad job fit may look like a “bad” employee.

Resources to Consider

Neuro-psycho metric Vocational interest and aptitude Worksite “diagnostic” analysis

Resources to Consider Using

Physical testing and training - occupational/work hardening– Cardiac rehab– Pulmonary rehab– Brain rehab– Special senses analysis and accommodation– Other specialty partners: diabetic, dermatology, allergy– Bio-dynamics lab

Resources to Consider Using

Questions?