Company Doctor, The

Company Doctor, The: Risk, Responsibility, and Corporate Professionalism

Elaine Draper
Copyright Date: 2003
Published by: Russell Sage Foundation
Pages: 412
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  • Book Info
    Company Doctor, The
    Book Description:

    To limit the skyrocketing costs of their employees' health insurance, companies such as Dow, Chevron, and IBM, as well as many large HMOs, have increasingly hired physicians to supervise the medical care they provide. As Elaine Draper argues inThe Company Doctor, company doctors are bound by two conflicting ideals: serving the medical needs of their patients while protecting the company's bottom line. Draper analyzes the advent of the corporate physician both as an independent phenomenon, and as an index of contemporary culture, reaching startling conclusions about the intersection of corporate culture with professional autonomy.

    Drawing on over 100 interviews with company physicians, scientists, and government and labor officials, as well as historical, legal, and statistical sources and medical trade association data, Draper presents an illuminating overview of the social context and meaning of professional work in corporations. Draper finds that while medical journals, speeches, and ethical codes proclaim the independent professional judgment of corporate physicians, the company doctors she interviewed often expressed anguish over the tightrope they must walk between their patients' health and the corporate oversight they face at every turn. Draper dissects the complex position occupied by company doctors to explore broad themes of doctor-patient trust, employee loyalty, privacy issues, and the future direction of medicine. She addresses such controversial topics as drug screening and the difficult position of company doctors when employees sue companies for health hazards in the workplace.

    Company doctors are but one example of professionals who have at times ceded their autonomy to corporate management. Physicians provide the prototypical professional case for exploring this phenomenon, due to their traditional independence, extensive training, and high levels of prestige. But Draper expands the scope of the book-tracing parallel developments in the law, science, and technology-to draw insightful conclusions about changing conditions in the professional workplace, as corporate cultures everywhere adapt to the new realities of the global economy.The Company Doctorprovides a compelling examination of the corporatization of American medicine with far-reaching implications for professionals in many other fields.

    eISBN: 978-1-61044-162-9
    Subjects: Health Sciences, Sociology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Preface
    (pp. vii-xii)
  4. Introduction
    (pp. 1-7)

    Professionals increasingly work in corporations, where they are subject to the decisions of company managers and to economic and legal imperatives stemming from their status as corporate employees. Ironically, as their numbers have grown, their autonomy has diminished. This trend is particularly stark in the case of company physicians, who share neither the independence nor the high status of the solo practitioner (see Sullivan 1995; Freidson 1986, 1994; Hafferty and McKinlay 1993; Sassower 1993).¹ Many processes that transform corporate professional work generally— such as corporate restructuring, the ascendance of legal departments, changing labor-management relations, and management by nonprofessionals—profoundly affect...

  5. Chapter 1 Corporate Professionals in Transition
    (pp. 8-39)

    In the filmOutland,the company doctor for a remote mining operation heroically aligns herself with the forces of justice (and the federal district marshal, played by Sean Connery), risking her life and livelihood to combat a lethal drug scourge that the company’s general manager has knowingly helped create. Referring to herself, this self-described alcoholic “wreck” of a company doctor (played by Frances Sternhagen) says: “You know, you haven’t your medical all-star here. Company doctors are like ships’ doctors. Most are one shuttle flight ahead of a malpractice suit.”¹ In the classic movieBrief Encounter,a general practitioner going off...

  6. Chapter 2 Loyalty and Professional Perils for Corporate Team Players
    (pp. 40-76)

    The doctor-patient relationship of hallowed tradition is transformed in corporations. Employers, nonphysician managers, insurers, and other third parties now play a role along with doctors and patients, even more than in private practice. Doctors worry about company costs and liability, and they often have considerable direct contact with other corporate sectors—such as legal, personnel, and environmental departments—that influence medical decisions.¹ Management may even try to tell doctors how they should differentiate between one diagnosis and another. The increasing pressure on professionals to serve as “team players” who serve the ends of employers and insurers affects not only company...

  7. Chapter 3 VIP Health Versus Eliminating the Thorn in the Side of Management
    (pp. 77-93)

    Managers often send to company physicians those employees whom management otherwise considers a problem— the individuals who are, in one doctor’s words, “a thorn in the side” of management. When physicians screen these individuals, they routinely turn information about their health over to management; in contrast, they generally guard information aboutexecutives’health carefully in what I call VIP health care in the workplace.

    Physicians and managers have sought medical explanations for troublesome employee conduct as well as for accidents and absenteeism. In doing so, physicians have helped medicalize managerial problems. At the same time they have also cooperated with...

  8. Chapter 4 Toxics and Workplace Hazards
    (pp. 94-136)

    Workplace health hazards produce an array of diseases in people who are exposed to them, ranging from skin damage to emphysema and brain tumors. Employers and the physicians who work for them have various motivations to reduce toxic exposures, including cultivating good relations with their employees, protecting a skilled workforce that is difficult to replace, and avoiding regulatory fines. They focus on chronic exposure hazards for several reasons: because prosperity allows them to hire in-house staff to address those risks, because management perceives that laws require them to do so, or because the company or industry recently has had an...

  9. Chapter 5 Drug Testing in the Workplace: The Allure of Management Technologies
    (pp. 137-155)

    Employers increasingly turn to employment policies that focus on drug users as a group that may pose a special risk in the workplace. They have been concerned about the catastrophic potential of allowing workers with a drug use problem to remain on the job. Drug testing in the workplace is an approach that conveniently sets aside any concern that repetitive or dangerous jobs may be contributing to drug use.

    Doctors employed by corporations have played an important role in the use of medical technologies to test for drugs. They use tests that they acknowledge are generally ineffective in detecting drug...

  10. Chapter 6 Workplace Screening
    (pp. 156-182)

    Faced with rising health costs and an increasing threat of lawsuits stemming from worker disease, many employers have adopted health screening policies that focus on individuals who may pose a special risk in the workplace. The prospects of higher costs for insurance and workers’ compensation, along with lawsuits and further regulation, keep employers interested in any means of identifying those with threatening medical conditions or personal habits. In recent years employers have screened workers for genetic predisposition to disease as well as for a broad array of health risks related to smoking, reproductive hazards, the AIDS virus, and biological traits...

  11. Chapter 7 Information Control and Corporate Professionalism
    (pp. 183-213)

    As nonmedical personnel increasingly gain access to medical information, the privacy of medical information and records is a growing social problem, with adverse consequences for patients and the public. In nonmedical corporations doctor-patient confidentiality tends to be even weaker than in private practice (see Snyder and Klees 1996; Rischitelli 1995). Employers use medical information in their decisions regarding hiring, firing, transferring, insuring, and compensating people (see National Academy of Sciences 1997; Draper 1991; Etzioni 1999).² Such information helps management to become aware of potential health hazards and to lower costs related to employees’ disease. Encroachments on confidentiality and privacy in...

  12. Chapter 8 Preventive Law by Corporate Professional Team Players: Liability and Responsibility in the Work of Company Doctors
    (pp. 214-255)

    Over the past several decades law has dramatically altered the relationship of professionals to colleagues, clients, and the public. It shapes professionals’ judgment about what constitutes appropriate professional conduct in many areas, including medical screening, employee placement, chemical emissions, medical malpractice, and responsibility for the costs of disease. Professionals follow news stories about litigation involving corporations and talk with colleagues and fellow workers about the meaning of court cases and statutory requirements. They tend to cast social questions and moral quandaries as legal matters, and their interpretations of the law have important effects on their decisionmaking The prospect of a...

  13. Chapter 9 Conclusion: Implications for Society and for Social Policy
    (pp. 256-266)

    Most theoretical and empirical studies approach professionalization and corporatization as if they were two very different and conflicting processes. But in fact, the professionalization process has oriented professionals to work in organizations, often large bureaucratic organizations. Professionals no longer identify only with their professional reference group; they also identify strongly with, or acquiesce in, the pursuit of corporate goals. Corporate pressures on physicians have intensified over the past four decades, as lawsuits, publicity about chemical risks, government regulation, and higher insurance and workers’ compensation expenses have raised employers’ costs.Professionalization and corporatization are intensifying simultaneouslyand in many ways reinforce...

  14. Appendix: Study Data and Methods
    (pp. 267-278)
  15. Notes
    (pp. 279-352)
  16. References
    (pp. 353-382)
  17. Index
    (pp. 383-396)
  18. About the Author
    (pp. 397-397)