Law, ethics and occupational health service delivery
Duties, consent and the two masters
Occupational physicians serve both worker and employer, and questions test whether you keep that boundary. The legal spine in the UK is the Health and Safety at Work etc. Act 1974 (general duties, 'so far as is reasonably practicable'), the Management of Health and Safety at Work Regulations 1999 (suitable and sufficient risk assessment, competent persons, health surveillance), COSHH 2002, RIDDOR 2013 (reporting specified injuries, diseases and dangerous occurrences) and the Equality Act 2010 (disability as a protected characteristic, duty to make reasonable adjustments).
Ethically the pillars are autonomy (consent), beneficence, non-maleficence and justice. Consent is required before any examination, and separately before disclosure of any medical information to a third party. The employer is entitled to fitness advice - 'fit', 'fit with the following restrictions', 'unfit' - not to a diagnosis. Reports should contain the minimum information necessary and should be shown to the worker where practicable; the Access to Medical Reports Act 1988 gives a right to see a doctor's report before it is supplied for employment purposes.
Traps: assuming a duty is absolute when it is qualified by 'reasonably practicable'; writing a diagnosis into a management report; giving verbal fitness advice that cannot later be evidenced; failing to record that consent was obtained and what it covered.
Worked example. A manager emails to ask whether an absent employee 'has cancer'. The correct response is to refuse disclosure, explain the fitness position in functional terms, and offer to agree with the employee what may be shared.
Rule of thumb: before writing anything, ask 'who needs this, and does the worker know I am sending it?'