1058 Clinical occupational medicine: a methodological frame for daily practice in occupational health

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Abstract

Objectives

Work-related mental disorders are often spontaneously described by workers as the result of bullying. In France, this phenomenon has emerged in 1998 parallel to the concept of perverse-narcissistic personality. Considering these situations only as the result of an intersubjective experience puts the working conditions themselves far away. But the working conditions may be responsible for such disorders in a three-dimensional view of activity (the self, the others and the work object) as described by Clot and Kostulski (2011). Our aim is to describe a method, using a relevant case-report, to better understand the links between work and mental health issues.

Methods

Clinical occupational medicine is a way to practice occupational medicine. This method allows the patient and the occupational physician to work by referring to concrete events or remembrances in order to better understand the links between work and health. The clinician seeks to switch from the talking points to the real thoughts of the patient. We perform these consultations to help occupational physicians to evaluate the workers’ fitness for their job, or to help workers suffering from work-related mental disorders to obtain compensation.

Results

Mrs Q, aged 58, worked as a medical secretary for a general practitioner. She accused him of bullying and was on sick leave. She was previously a housewife during 10 years and before she had a job experience in catering. Her husband has helped her to get this job. She worked during 11 years with an old GP. She had no training to be a medical secretary, but she did not have any trouble to work. It was the old way, with paper files and schedule. This GP has retired and was replaced by a young one – the new way, with computerised files. The secretary started being in trouble: she delivered medical files to right-owners concerning old patients living in retirement houses regardless to the legal considerations and provided a risk of prosecution for the GP. She was also in trouble with the use of computers. In fact, she felt bullied whereas her employer was accusing her of mistaking. On the other hand, her employer has never asked her if she was in trouble and never proposed any help.

Conclusion

The spontaneous speeches from patients often give intersubjective explanations to their work-related mental disorders. Thus the easier way to answer the problem is to eliminate the bully. However, the work object or conditions may drive someone into a bullying behaviour. Having a three-dimensional approach allows proposing more efficient solutions, more tailored to individual situations (e.g. a specific training).The clinical practice allows guiding patients who present psychiatric disorders. This case-report also illustrates the huge gap between spontaneous speeches (‘I am bullied’) and the clinical work performed by a physician or a psychologist. Regarding this fact, we should be very cautious when using self-administered questionnaires.

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