Epilepsy and employment: A qualitative interview study with heads of human resources and occupational physicians in Austria - A call for legislative optimization according to the WHO Intersectoral Global Action Plan

Abstract

Objective: People with epilepsy (PWEs) often face difficulties in obtaining or keeping employment. To determine the views on this topic of the heads of human resources (HHRs) and occupational physicians (OCPs).

Method: Twelve HHRs and five OCPs underwent a telephone interview concerning the opportunities and limitations of job applications for PWEs. The interviews were performed in May 2020, in the federal state of Salzburg, Austria, and they were analyzed using the qualitative method of content analysis (Kuckartz). The legal situation was investigated according to Global target 5.2 of the Intersectoral Global Action Plan (IGAP) on epilepsy and other neurological disorders 2022-2031 by WHO.

Results: Employers were confident that employees with epilepsy could be managed well in a positive company culture and with first responders in place. The Austrian law predisposes to uncertainty among both employers and employees. In particular, it allows only retrospective juridical clarification of health-related questions in the job interview. The authors developed a classification system of workplaces, with "D0" (D-zero) meaning no health or financial danger, for example, office workers and "D1" posing still no health hazard but includes regular work with cash, for example, salespersons. "D2" means potential medical implications for the person with epilepsy or any other person at the workplace, for example, industrial worker. Measures taken to abandon the risk in D2 workplaces, for example, a total sheath for a machine, leads to reclassification as "D2-0." With D2, OCPs evaluate the applicant's medical fitness for the job without disclosing medical details to the employer. The "compartment model of medical information in the job application process" guarantees that OCPs are the only persons who learn about the applicant's medical details.

Significance: The practical and simple classification of workplaces according to the D-system, and the concept of making medical information accessible only to OCPs may diminish stigma and discrimination in the working world for PWEs.

Keywords: D‐system; IGAP; application; legislation; stigma.

FIGURE 1

Categories of workplaces, for example, in epilepsy (“D‐SYSTEM,” “D” denotes danger). All workplaces are classified into three categories: “D0” (D zero) without any health risks for all persons (customers, employer, all employees) and no work with cash, for example, office work by architects, technical drawers, clerks, and secretaries. In category “D1” there are still no health risks but regular work with cash, for example, salespersons. Employers may downgrade “D1” to “D1‐0” (“D‐one–zero”) in cases where the employers manage the work with cash by other means. In category “D2” there are potential health risks for the employee, the co‐workers, the customers, or the employer, for example, industrial jobs with machines. In “D2” the occupational physician assesses the individual suitability of a person with epilepsy for a particular workplace. This is done by communicating “suitable,” “non‐suitable,” or “conditionally suitable,” that is, after adaptation or optimization of the workplace. In “D2‐0” (“D‐two‐zero”) the health risk was normalized by protective measures, for example, a full sheath of a machine (Figure S2).

FIGURE 2

The “compartment‐model of medical information in the job application process” (CMI) shows the flow of information during the job application process. The strict separation of professional and medical information during the job interview is the core of this concept. Professional information refers to data discussed between the employer and job applicant during the job interview (1) and the specific composition of the workplace (2) communicated by job advertisements (3) and workplace viewing by job applicant (4). Most importantly, no medical information is transferred from job applicant to employer (5). The occupational physician (OCP) (6) learns both the job requirements communicated from the employer to the OCP (7), job details obtained by workplace and worksteps viewing by the OCP (8), and the medical condition of the job applicant (9). Based on all this information the OCP establishes a medical judgment (10). The OCP communicates the suitability in the three categories “suitable,” “conditionally suitable,” (i.e., with opportunities to optimize the workplace), and “non‐suitable” (11). No further medical information is transferred to the employer, especially no medical diagnoses, medical details, or medical reasoning (Figure S3).