Background
Methods
Theoretical approach
Study participants
Physicians | Primary Care Physicians | Occupational Physicians | Rehabilitation Physicians | Patients | |
---|---|---|---|---|---|
Participants | n = 22 | n = 9 | n = 12 | n = 15 | Participants |
Age Average [Median/(Range)] | 57 / (40–67) Years | 55 / (45–65) Years | 48 / (34–58) Years | 53 / (22–63) Years | Age [Median / (Range)] |
Sex: nbr. Female | n = 9 | n = 5 | n = 6 | n = 8 | Sex: nbr- fem. |
Work experience as physician | 27 / (13–40) Years | 29 / (12–39) Years | 13 / (6–30) Years | One: n = 4 Two: n = 1 Three: n = 1 | Previous rehabilitation therapies |
Work experience in specialization [Median/(Range)] | 21 / (7–33) Years | 20 / (1–32) Years | 11 / (3–31) Years | ||
Type of employment | Solo practice: n = 13 Group practice: n = 9 | Employed at enterprise n = 1 Employed in occupational health service: n = 4 Freelance: n = 4 | all employed at the rehabilitation clinics | 21 days: n = 4 28 days: n = 3 35 days: n = 5 > 35 days: n = 3 | Planned duration of rehabilitation (days) |
Practice site | Urban: n = 2 Rural: n = 10 Mixed: n = 10 | Urban: n = 5 Rural: n = 0 Mixed: n = 4 | N.A. | Mental health n = 5 Musculoskeletal n = 5 | Reason for rehabilitation |
Practice size (patients per 3 months) | < 700: n = 2 700–1400: n = 14 > 1400: n = 5 | Responsible for SME: n = 8 | N.A. | Office work: n = 5 Industrial production: n = 3 | Occupation |
Rehabilitation applications [Median/(Range)] | 35 / (5–50) per Year | N.A. | N.A. | Construction work: n = 1 Logistic sector: n = 1 Nursing care: n = 2 Pedagogue: n = 1 Cleaner: n = 1 | |
Small or medium enterprises: n = 7 | Type of employer | ||||
Business has OP: n = 8 Patient knows OP: n = 7 | Relationship to OP (responses by patients) | ||||
Setting of data collection | Meeting room in University Hospital Tübingen or in our institute in Tübingen | Meeting room in our institute in Tübingen & Conference room in Stuttgart | Meeting room in rehabilitation clinics | Meeting room in rehabilitation clinics | Setting of data collection |
Data collection
Data analysis
Results
Cooperation with OPs in the rehabilitative health care system
Excerpt from PCP-FGD-I: Interviewer: “[When thinking about OPs], where do you see their position, their relevancy [in the rehabilitation process]?” PCP: “We don’t know, as we do not know what they are doing at the moment. In the past 18 years, I never been in touch with an OP. Other than sometimes patients coming to my practice […] and telling me that their OP had told them that their cholesterol or liver enzymes were elevated. But beyond that, I don’t hear anything. There really is no communication with OPs.”
Self-perception of medical protagonists
In-group perception of OPs
Excerpt from OP-FGD-II: “OP1: […] I do believe we provide a valuable contribution. Who really knows the work on site and can link health to occupation, and occupational burden to health?” OP2: “Yes, precisely” OP1: “That’s the OP!” OP2: “Yes, definitely” OP3: “He/She is the lighthouse!”
In-group perception of PCPs
In-group perception of RPs
Excerpt from RP-FGD-I: “What is health? Being able to live and work – according to Freud. And this is exactly what we [as RPs] do here”.
Perception of professional groups by others
Out-group perception of OPs
Excerpt from PCP-FGD-I: “In most cases communication is established through our [PCP] initiative and is mostly a negative experience. […] [PCP gives an example of a patient he provided with a certificate of incapacity for a certain task]. This has never been successful, never! Instead, the patient returns to his workplace and the OP says: someone must do this job. This is why we get little joy from [cooperating] with them [OPs]. Because they just don’t care at all about our recommendations. […] They should be obliged to report why they can’t implement it. And they should be obligated to prove that they were not bought by the company and do not primarily work in the interest of the employer […].”
Out-group perception of PCPs
Out-group perception of RPs
Excerpt from OP-FGD-I: “One has to ask oneself: who becomes an RP? […] Are these the ones who are most dynamic? Who want to achieve something? Or rather those who tell themselves: it is quite comfortable being in this position”
Group-based comparisons and distinctions
An example for the distinctions through devaluing based on value-laden attributes is the clear, dichotomous distinction made by PCPs between themselves, the highly committed and diligent PCP working to help and protect their patients, and the well-paid OPs with short working hours and little commitment to the patient’s well-being. A similar distinction was made regarding RPs, who according to PCPs worked few hours and had low levels of occupational stress, while PCPs portrayed themselves as having a high workload and little time to spare.Excerpt from OP-FGD-I: OP1: “ [It is good that the PCP takes on the role of coordinator in the rehabilitation process]. But the [coordination] within the workplace, that is in good hands with us. Because, with a positive patient image, a positive scope of performance levels, and [knowledge of] the workplace requirements, we are much better-suited to evaluate what is possible and sensible.” OP2: “Yes, because the PCPs don’t have any insights. It would be presumptuous if they asserted they could do this.”
Excerpt from PCP-FGD-I: PCP1: “[…] I never felt the need or had particular interest [in cooperating with OPs]. Because we will talk to them over the phone for an eternity, and nothing comes out of it” […] PCP2: “Those OPs have an unsavory taste. […] It is a relaxed occupation: they start at 8 in the morning, are at home at 4 PM, and are well-paid for that by the company. They don’t have any responsibility; don’t need to spring into action during the night. [..] Maybe there is a little envy talking from our side.”
Excerpt from PCP-FGD-I: “The level of contact is close to nil. They sit around somewhere and have an easy job in my view. You can see that from their (lack of) availability in the morning at half past seven or in the afternoon after four PM. We have close to no points of contact”
Perception-based barriers to cooperation with OPs in the rehabilitation process reported by protagonists
Henchmen of employer
Excerpt from OP-FGD-I: “I am a doctor for internal medicine by training and have worked in the hospital for many years. Do you believe I would have taken an OP seriously? Not at all! […] What do they want? That is actually the employer! I won’t tell them anything!”
Excerpt from RP-FGD-I: “But to the company physicians, there’s hardly any contact, if any. And that has a lot to do, speaking from my own experience here, a lot to do with prejudices and fears [of the rehabilitants] that confidentiality will be neglected regarding their employers, etc.”
OPs as optional protagonists
Less dedicated & limited agency
Excerpt from OP-FGD-I: “At the times when we have the time to call them, you cannot reach anyone, because it is lunch break again or after 7 PM”. “Actually, they [OPs] should be the ones responsible for trying to get in touch with us”
Discussion
OP | PCP | RP | |
---|---|---|---|
In-Group perception | ● Working in the interest of patients ● Profound knowledge of workplace; which others were lacking ● Experts on interface between occupation and health ● Well-suited to be coordinators in rehabilitation process ● Good relationship with their patients ● Role in rehabilitation process not known and adequately valued ● Important for successful rehabilitation process | ● Hardworking ● Dedicated to patients ● Advocates for their patients ● Important for successful rehabilitation process ● Good and intensive relationship with patients | ● Profound knowledge of patients workplace ● High workload and unjustified demand from patients ● Dedicated to cooperation with other protagonists ● Promoting patients’ physical health, social well-being, and occupational participation |
Out-group perception | ● Henchman of the employer ● Limited agency ● Not hardworking ● Not working in the interest of patients ● Patients don’t know them ● Role and function in rehabilitation process unclear ● Not interested in cooperation | ● PCPs and OPs are competitors ● Not interested in cooperation | ● Not interested in cooperation ● Insincere concerning reported rehabilitation outcomes ● Not interested in the patients’ health after end of rehabilitation ● Not hardworking ● Not very ambitious |