This article by Dr Jean Lennane appeared in the February 1994 issue of NSW Doctor, the journal of the NSW Branch of the Australian Medical Association. While the guidelines for psychiatrists mentioned here have since been modified somewhat by the AMA to expand their scope, the content of this article provides a clear insight into the ongoing practice of sending Whistleblowers to medical appointments as a means of attempting to discrediting them.
The article is reproduced here in its entirety.
Suppression of dissent website
in the section on Documents
Many Australian workers are becoming ill from work stresses which are either deliberately or negligently caused by employers - problems that have increased in tough economic times and, which cost the community dearly in lost productivity and chronic ill health.
In April last year, NSW Branch Council adopted guidelines for psychiatrists treating whistleblowers referred at the instigation or insistence of their employer. But often there are broader issues than those in the guidelines. Medical consultations can also be used to victimise in other situations, for example: where an employer wishes to shed an employee who is preventing staff reductions or the appointment of a favourite; incompetent supervisors want to cover their incompetence; employees who have criticised inferior or unethical work methods; "mobbing" behaviour where individual employees are victimised by workmates and the employer fails to prevent such victimisation.
Victimisation commonly involves assignment to menial tasks, criticism and denigration ("counselling"), rejection of input, demotion, isolation (physical and from communications), restriction of training and other opportunities, threats of disciplinary action and intimidation of supportive fellow workers. The pattern of victimisation tends to be remarkably similar from case to case.
Employees in these situations commonly become anxious, depressed and develop other somatic symptoms of stress (eg ulcers, hypertension, sleep disturbance). They usually present to their GP voluntarily because of multiple symptoms, and may have to take extended periods of sick leave. They are also commonly referred to a doctor or doctors of the employer's choice, sometimes because of increasing time off work, but often as part of the victimisation process.
The employer then hopes to discredit them as mentally unbalanced or ill or to get evidence to justify retiring/ dismissing them on medical grounds. Employees are likely to find the demand for such consultations degrading and distressing and, irrelevant to the real underlying problems.
Doctors need to be aware of the possibility of being used as an extension of the victimisation process. The ethical responsibility is always to the patient, even if the doctor is also being paid by the employer. If the patient makes it clear they are not genuinely consenting to the examination, but are attending under duress, the doctor should not continue and should inform the employer that if an opinion is indeed necessary, it should be sought from the patient's usual GP, or specialist chosen by the GP.
If the patient does agree to be examined, then the doctor should ascertain whether it is a victimisation case. This is often clear from the history, previous pattern of sick leave, and whether the underlying issues appear to have been addressed. If there is still some doubt, eg: on whether the patient is in fact inefficient, corroboration should be sought from an independent source (colleagues, previous supervisors) rather than the alleged victimiser.
At all times, the patient's interests should be paramount, and there should be no communications with the employer that the patient has not agreed to. Even a statement of fitness or unfitness for work can be problematic. In what may be a finely balanced situation, a report from a psychiatrist saying that the employee is unfit for work because of anxiety and depression caused by the stress, can be misused by the employer to claim the employee's concerns are irrational and justify the victimisation that has in fact caused their illness. Certificates have to be carefully worded to prevent such misuse.
The doctor can be of considerable help in putting pressure on the employer to remedy the underlying situation, by pointing out that the problem appears to be primarily managerial rather than medical. While the employee can be treated symptomatically, this is much less satisfactory that correcting the underlying mismanagement and, creating the safe psychological and physical working environment required under occupational health and safety legislation. If the doctor considers the health problem is in fact caused by stress at work, this should be clearly stated. The employee often needs time off work to recover and sort out options for redress, to seek alternative employment (usually limited in the current economic climate) and be supported in deciding whether they will suffer more by walking away from the problem or staying to confront a far greater force and further health damage.
* Dr Jean Lennane is a psychiatrist in private practice and a member of the NSW Branch Council.