From the frontlines… Straight talk from the doctor’s office—the occupational health doctor’s office

April 14, 2016

This month we decided to get the word on the street—or should we say, the word from the doctor’s office—the occupational health doctor’s office (which is just a fancy way of saying a doctor who works right onsite at the workplace). Who better to provide us with insight into plan member health than the kind of doctor who is in the trenches day in and day out seeing patients in clinical settings and the workplace? Introducing Dr. Alain Sotto—he supports individual plan members and, through his work, he helps plan sponsors create strategies to address health issues impacting the overall employee population. Now that’s the kind of unique perspective we need to hear about…


When asked what the number one health issue he sees in his workplace practice, Dr. Sotto is quick to answer, “Clearly, it’s chronic conditions: diabetes, cancers, cardiovascular conditions, mental health issues, and musculoskeletal conditions like arthritis.” And he goes on to say that “it’s obvious that the effects of chronic conditions—meaning poor quality of life followed by premature death—are devastating for plan member health. But that’s not the whole story, the effects are also devastating for an organization’s costs and productivity. And here’s the kicker, even with chronic conditions already at an epidemic level, their incidence in Canada is rising each year. In fact 51.8% of Canadians have at least one chronic disease and 14.8% have two or more chronic diseases. So we know that the number one plan member health challenge is chronic conditions—the urgent question is, what are plan sponsors going to do about it?” 

‘Plan members spend most of their waking hours at work—it’s the ideal place to make an impact’

Although many plan sponsors are taking action to help improve plan member health, Dr. Sotto often finds that those who aren’t see chronic conditions as an issue that our health care system should address. “Preventing and managing chronic conditions requires a concentrated, ongoing effort that requires time—precisely what the family doctor doesn’t have. The family doctor’s short office visits focus mostly on acute care, and this is just not going to cut it. We have to work as a team—everyone from the family doctor and other health care professionals, to benefits providers and plan sponsors, to the plan members themselves—we all have to get in on the act.” 

In terms of teamwork, he points out that what he sees in many workplaces is that they historically rally around the concept of plan member safety. (Hint: that is legislated.) However, by contrast, plan member health is the poor cousin that doesn’t receive its fair share of attention. “Although most organizations have health and safety committees—with everything from educational materials and presentations about safety topics to training programs about how to stay safe—the focus is on safety, safety, and more safety—it’s rarely about health. Organizations need to make a paradigm shift—they need to make a fundamental change in their approach to plan member health that raises it to the same status as plan member safety—it’s a matter of improving lives and downstream costs.”

‘What is the cost of a life?’

The perception that health management programs can be costly is another barrier, however, there are many inexpensive options. “The reality is that the cost of doing nothing is too high. I tell plan sponsors to view the return on investment [ROI] of health management programs within the context of improving plan member lives, or even better saving their lives and improving organizational profitability. Early detection of chronic diseases and of the risk factors to chronic disease reduces the risk of much higher costs now and in the future. The reality is that it’s just not possible to run a business if employees simply aren’t there. They may be absent temporarily or they may end up on long-term disability and absent for good…or worst-case scenario, literally gone for good, as in dead.”

‘Let the numbers do the talking’

Research shows that sponsors are looking for more information and analysis regarding their plans, and Dr. Sotto feels data is essential to guide health management initiatives. “I tell plan sponsors to start by analyzing their plan’s drug usage related to the top five to ten chronic conditions—this is essential to provide insight into the conditions for which plan members are receiving treatment. Combine this data with other claims data and indicators like absenteeism rates, and the numbers will reveal which health issues to focus on. Then plan sponsors need to make sure their programs address the complex nature of chronic conditions by incorporating numerous strategies to educate, engage, empower, and enable plan members to take action.”

‘There are lots of successes out there’ 

In terms of real-life success stories, Dr. Sotto shares the diabetes and metabolic syndrome (a precursor to diabetes) prevention program that he recently spearheaded at the Toronto Transit Commission (TTC) in 2015 and a few years ago at Ontario Power Generation. Activities to reach plan members included: 

  • In-person educational presentations by Dr. Sotto about metabolic syndrome and diabetes; posters; onsite blood pressure testing; onsite pinprick blood sugar, cholesterol, and A1C (three-month glucose average) testing; and a special insert in the staff newsletter that included a “know your numbers” chart that plan members could review with their family doctor.
  • Screening programs to determine whether they have any of the warning signs for metabolic syndrome or diabetes or hypertension. 
  • Resources about the lifestyle changes they could make to prevent and, as necessary, effectively manage metabolic syndrome and diabetes, such as dietary advice and access to exercise facilities.

The colorectal cancer screening program at the TTC provides another example of a health management program that used a range of activities to reach plan members:

  • In-person educational presentations and a DVD of Dr. Sotto explaining what colorectal cancer is and the role of prevention. 
  • Information about what is considered the gold standard for prevention—the colonoscopy, which can catch polyps before they become cancerous, and if cancer exists, it can detect it early.
  • Referral forms to clinics that provide colonoscopies to those over 50 years old were attached to pay stubs and were made available on the intranet.

Dr. Sotto considers Ontario Power Generation and the TTC as organizations that have made the paradigm shift—their focus is on health and safety.

To sum it up, Dr. Sotto leaving us with this big picture message: “As I mentioned, overall plan sponsors need to take a hard look at their approach to workplace occupational health and safety—that’s health and safety. Although an emphasis on safety is entrenched in most workplaces, employees can’t be truly safe unless they are first healthy. Employee health is in fact an essential part of keeping employees safe. Put the health back in health and safety.”