Role of medical screening in the prevention of occupational disease

Article Abstract:

Occupational medical screening is intended to detect adverse health conditions that result from hazards and diseases existing in or derived from the workplace. Controls of hazards are frequently determined and applied on the basis of clinical medical judgments and observations of individuals. The most effective control of occupational disease is by primary prevention, which means diminishing or preventing exposure. Secondary prevention, or treatment of the exposed, is less effective in reducing disease. Screening programs are intended to supplement control efforts, not replace them. The importance of screening is that it contributes to the early detection of disease in the individual, and by extension, to those who share his/her exposures and risks. The group obtains the greatest benefits when recommendations are collated and the means of interrupting the exposure-disease chain can be ascertained. Screening for bladder cancer should follow the same set of principles, but effective screening tests for occupationally-related bladder cancer among high-risk groups do not exist. Diagnostic tests are intended to provide direction for medical treatment of a person who is ill. Screening is directed at the person who is asymptomatic and does not feel sick. These tests must meet a set of criteria that will identify the area, activity, and persons at risk, encourage participation and client acceptability, establish means to determine positivity and borderline status, and suggest a management procedure for the borderline and positive cases. The Occupational Safety and Health Administration (OSHA) has issued a notice of proposed rulemaking for a generic approach to the development of standards for testing and surveillance. The National Institute of Occupational Safety and Health (NIOSH) supports this generic approach and is developing recommendations for threshold exposure guidelines and levels, testing and screening criteria, and other related issues. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Management, Diagnosis, Causes of, Occupational diseases, Medical screening, Health screening, United States. National Institute for Occupational Safety and Health

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Implementation of the federal Hazard Communication Standard: does training work?

Article Abstract:

The Hazard Communication Standard (HCS), promulgated by the Occupational Safety and Health Administration (OSHA) in 1983, required the evaluation of health hazards, labeling of containers, the creation, use and dissemination of material safety data sheets (MSDSs), and employee training. This training was to include information about the identity of hazardous compounds to which workers may be exposed, the health and physical hazards associated with the compounds, the means to detect exposure, and methods for protecting workers against the adverse effects of exposure. The standard is a ''performance based standard'', specifying what must be done, not how it is to be done. The authors present an evaluation of a training program that was intended to bring a United States manufacturing firm into compliance with these regulations. The firm had 50 facilities throughout the country. The program was jointly developed, managed and implemented by the union and management. The evaluation process was set up to: (1) measure planning and implementation at five sites; (2) assess direct program impact on employee attitudes, knowledge and work practices; and (3) assess indirect impact of the program on plant working conditions, and other health- and safety-related activities. Data were collected in three phases; as training was completed, one year after training, and two years after training. The responses were catalogued and, in general, indicated moderate success in the study sites. The design, construction and presentation of the program had significant impact on the success of the training effort. This program was presented differently in the five locations, resulting in different degrees of success. Subsequent training and safety efforts met with greater success when the need for adopting a uniform presentation was recognized and applied. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Occupational health and safety, Occupational safety and health, Study and teaching, Hazardous substances, Employee safety education, Employee training, Hazard Communication Standard, Material safety data sheets

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Suing the doctor: lawsuits by injured workers against the occupational physician

Article Abstract:

Physicians practicing in the field of occupational medicine are beginning to realize that they can be sued. They can be sued for malpractice by the patient and/or the compensation insurer. In some states even an in-house physician can be sued by a co-employee/patient. A physician commits malpractice if his treatment does not follow a reasonable standard of care. Two areas of particular concern to occupational physicians are failure to advise the patient of an adverse condition or future risk, and returning the patient to work either too early or without adequate work restrictions. Occupational physicians are often caught between the opposed pressures of the company wanting the employee to return to work quickly and the employee/patient wanting to gain his maximum compensation benefit. If the physician's main loyalty is to the employer, as when performing a pre-employment physical, this should be made clear to the patient. If a true physician-patient relationship exists, the physician must inform the patient of any adverse conditions or risks. When a worker files a claim for worker's compensation he waives his right of confidentially. The physician must be sure the patient understands this before any confidential information is released. The physician must be aware of government regulations that protect the confidentiality of medical records, such as drug and alcohol abuse records. In general, a physician cannot be sued for expressing his opinion regarding a worker's ability to work; however, he can be sued for written libelous statements. The author suggests that physicians have adequate malpractice insurance and that in-house physicians have a written indemnification agreement with their employers.

Physicians, Malpractice, Medical malpractice, Medicine, Industrial, Industrial medicine, Workers' compensation

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