Research Project
Type of Project: Scientific Work
The cooperation between rehabilitation physician and company medical officer: An approach from computational linguistics to identify information in discharge reports

Background
Both rehabilitation physician and company medical officer are responsible for fostering employability and reducing sick leave of diseased employees (Enderle et al. 2010). This can be achieved more easily if communication between these partners works well during the entire rehabilitation process (Kühn et al. 2008). As a necessary prerequisite, the rehabilitation physician needs to inquire the patient whether a company medical officer is available.
So the following questions were analyzed:

1) Does the rehabilitation physician mention information on the availability of a company medical officer in the discharge report?
2) Does the rehabilitation physician consider the company medical officer as a potential partner in treatment, especially for the time after discharge?

Methodology
An approach from computational linguistics has been applied to identify information on company medical officers in the discharge reports. We employed 63,490 reports from our research database “Patientenkonto“ (Kaluscha 2005). The reports in the database have been stripped of information identifying patients to protect their privacy. The database includes both structured medical information, e.g. diagnosis, and narrative texts which usually follow a common scheme. These texts were analyzed, especially the chapters on “work and occupational history” and “social epicrisis” were searched for the term “company medical officer” or related terms.

Results
The corresponding computational linguistic queries scored in 10,198 reports (16.1%). This yielded significant differences between rehabilitation clinics; the rate of discharge reports mentioning a company medical officer ranged from 44.4% to 3.5%.
Among these, 3,574 reports stated that the patient had been asked about a company medical officer, but he claimed none was available. In 6,216 reports the company medical officer was mentioned without a negation in the same sentence, i.e. 61% of the 10,198 reports provide evidence for the availability of a company medical officer.
A more detailed analysis identified the chapter in the report where company medical officer was mentioned. In 4,198 cases the computational linguistics query matched in the chapter „work and occupational history“ but not in the epicrisis which usually contains recommendations for further treatment. Thus, the opportunity to involve the company medical officer in the rehabilitation process might have been missed.
In 1,063 reports the company medical doctor was mentioned in the epicrisis. So we assume that in these cases the rehabilitation physician assigns him a part in the process.
Only in 319 cases the company medical officer was mentioned in both chapters.

Discussion
In just one out of six reports the company medical officer has been mentioned. This quite rate could be interpreted as a failure of the rehabilitation hospitals to identify the company medical officer as a potential partner in the rehabilitation process, thus possibly reducing patients’ chances to return to work successfully.
However, another explanation could be that the patient didn’t provide information on a company medical officer or refused to involve him, as some patients are afraid he might represent the employer’s interest instead of theirs. Nevertheless, this could also be recorded iin the discharge report to clarify that this path has at least been tried.
However, even if a company medical officer is mentioned this does not necessarily guarantee an intensive exchange of information between both physicians. If a company medical officer would be available, but is not involved in the rehabilitation process, potential for integration at the workplace is wasted. According to a study by Tave (2005), 93% of the company medical officers stated that they rarely cooperate with rehabilitation clinics though they would be willing to do so.
Even though there is strong evidence for the benefit of a close cooperation between company medical services in major enterprises and rehabilitation clinics (Haase et al. 2002, Kühn et al. 2008), small or medium-sized enterprises are not required to have a permanent company medical officer so for their employees matters might become complicated (Enderle et al. 2010).
The cooperation between rehabilitation physicians and company medical officers: an evaluation of discharge reports

Future Prospects
It is important to encourage the rehabilitation physicians to seek cooperation with the company medical officer routinely. If the patient is doubtful about whose side the company medical officer is on, the physician should discuss the potential benefit of involving the company medical officer with the patient. Furthermore, the physician needs to explain to the patient that the company medical officer has to keep professional discretion towards the employer. Thus, both patients and employers might benefit from an intensive cooperation between rehabilitation physicians and company medical officers.