In Part Two of “RTW relationship hurdles: doctors / employers,” we not only teach you how to clear common relationship hurdles by a foot or two, we also give you the tools to dismantle them before they become a problem. At the Olympics, they’d call it cheating, but in the RTWMatters office, we're handing out gold medals all round!

If you’ve forgotten what the common barriers look like, you might want to refresh your memory with a reread of Part One. Otherwise, get ready to rumble.

Hurdling existing barriers

The first step to clearing doctor / employer relationship hurdles is being aware that they exist. A poor doctor / employer relationship may be at the root of delays if:

• The doctor doesn’t return calls or deal promptly with paperwork;
• The doctor sounds hostile or unengaged when you do speak with him or her;
• You have good reason to suspect that the patient is being over-treated; or
• You have good reason to suspect that the doctor is unnecessarily delaying return to work.

Communication is the key to hurdling relationship barriers. If  you suspect that the doctor / employer relationship is on the rocks, you don’t need to pull out all the stops: a simple phone call may suffice to clear the air. Avoid making accusations: simply ask the doctor for their perspective on barriers to return to work. Where appropriate, make it a conference call and ask the employee if they’d be willing to provide input, bearing in mind that there may be issues around confidentiality.

The doctor's perception of the barriers will vary from case to case, but once you’ve identified them, take steps to resolve them to all parties’ satisfaction. In doing so, some of the strategies for dismantling relationship barriers described below may be of assistance.

Dismantling barriers to good relationships

There are five “tools” you need to dismantle barriers to a healthy doctor / employer relationship:

1. Simplicity – Make it simple for the doctor;
2. Time – Make the process as time efficient as possible;
3. The employee – Involve the employee wherever possible;
4. Confidentiality – Demonstrate respect for and knowledge about confidentiality provisions; and
5. Appropriate remuneration – Pay doctors for their hard work, including phone conversations where appropriate.

These tools will be of assistance if you've gotten to the stage where a poor relationship is a problem, and they also provide an excellent foundation for building a healthy doctor / employer relationship to begin with. Dr Carlo Ammendolia of Toronto Western Hospital, Canada has conducted extensive focus groups with RTW stakeholders and he has some creative suggestions as to get doctors on side.

"When the patient goes to see the doctor, instead of having the doctor provide information about the worker's limitations - how much they can lift? or how long can they sit? - the employer can provide the employee with a list of alternative work duties, described in some detail. You might include simple tasks such as sweeping the floor, or a more complex job, described specifically.  Make the doctor aware of the different jobs available.

"The doctor can then tick off a box and say, yes, he can do this job, and he should probably do it for two weeks. This is much easier for the doctor than having to say, this is how much he could lift, this is how long he can sit. They don’t have the expertise to be able to do that. But they can say, 'Yes you can sweep the floor, yes you can go up the stairs if you only have to do it 3 times a day.' The doctor feels much more comfortable when the employer says, 'Hey, we’ve got lots of jobs we could get the employee to do, just tick off the ones that he can do and we’ll take it from there.'

"The doctor also gets the sense that the injured worker is involved in the return to work process and it is simple and saves time."

The doctor / employer relationship is easy to overlook in the tangled web that RTW sometimes becomes, but it is an important one. As Dr Ammendolia's suggestions demonstrate, getting it right doesn't have to be a headache: empowering the employee to make things simpler for the doctor can do wonders.