title: Is clinician refusal to treat an emerging problem in injury compensation systems?
abstract: OBJECTIVE
  The reasons that doctors may refuse or be reluctant to treat have not been widely explored in the medical literature. To understand the ethical implications of reluctance to treat there is a need to recognise the constraints of doctors working in complex systems and to consider how these constraints may influence reluctance. The aim of this paper is to illustrate these constraints using the case of compensable injury in the Australian context.
  
  
  METHODS
  Between September and December 2012, a qualitative investigation involving face-to-face semistructured interviews examined the knowledge, attitudes and practices of general practitioners (GPs) facilitating return to work in people with compensable injuries.
  
  
  METHODS
  Compensable injury management in general practice in Melbourne, Australia.
  
  
  METHODS
  25 GPs who were treating, or had treated a patient with compensable injury.
  
  
  RESULTS
  The practice of clinicians refusing treatment was described by all participants. While most GPs reported refusal to treat among their colleagues in primary and specialist care, many participants also described their own reluctance to treat people with compensable injuries. Reasons offered included time and financial burdens, in addition to the clinical complexities involved in compensable injury management.
  
  
  CONCLUSIONS
  In the case of compensable injury management, reluctance and refusal to treat is likely to have a domino effect by increasing the time and financial burden of clinically complex patients on the remaining clinicians. This may present a significant challenge to an effective, sustainable compensation system. Urgent research is needed to understand the extent and implications of reluctance and refusal to treat and to identify strategies to engage clinicians in treating people with compensable injuries.
authors.affiliation: Department of General Practice, School of Primary Care, Monash University, Melbourne, Victoria, Australia.
authors.forename: Bianca
authors.initials: B
authors.lastname: Brijnath
authors.affiliation: Department of General Practice, School of Primary Care, Monash University, Melbourne, Victoria, Australia.
authors.forename: Danielle
authors.initials: D
authors.lastname: Mazza
authors.affiliation: Institute for Work & Health, Toronto, Ontario, Canada.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Kosny
authors.affiliation: Department of General Practice, School of Primary Care, Monash University, Melbourne, Victoria, Australia.
authors.forename: Samantha
authors.initials: S
authors.lastname: Bunzli
authors.affiliation: Department of General Practice, School of Primary Care, Monash University, Melbourne, Victoria, Australia.
authors.forename: Nabita
authors.initials: N
authors.lastname: Singh
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Rasa
authors.initials: R
authors.lastname: Ruseckaite
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, Victoria, Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Collie
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001315:Australia; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D060051:Occupational Injuries; D011320:Primary Health Care; D016079:Refusal to Treat; D062707:Return to Work; D013038:Specialization; D014942:Workers' Compensation
keywords: MEDICAL ETHICS; OCCUPATIONAL & INDUSTRIAL MEDICINE; QUALITATIVE RESEARCH