Occupational Medicine

This document has been endorsed by the American Academy of Family Physicians and was developed in cooperation with the American College of Occupational and Environmental Medicine, the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the Society of Teachers of Family Medicine.

Input from the medical community is required to maintain the highest quality of workplace health and safety. Since more than one-half of American workers are employed by companies with fewer than 50 employees, it is apparent that many industrial locations do not have a full-time occupational physician on site. When the incidence of occupationally-induced illness and injury is considered, the importance of occupational medicine training to the family practice resident becomes apparent.

The ability to integrate the occupational history into the standard history and physical examination should receive special emphasis in each training program. An important component of medical practice is a complete pre-employment assessment, as well as periodic follow-up examinations as necessary. This importance should be emphasized from the workers standpoint of disease detection as well as prevention. The family practice principles of continuity and comprehensiveness should not be forgotten in the health management of the worker. When injury occurs, physicians must be concerned with the injury, prevention of reoccurrence and the biopsychosocial consequences.

Attitudes

The resident should develop attitudes that encompass:

Awareness of their own attitudes and their personal and family experiences toward the jobs of employees and employers, and the potential implications on the therapeutic relationship.
Recognition of the importance of the physician/employee/employer partnership in promoting and maintaining optimal health in the workplace.
Sensitivity to cultural beliefs and values, family dynamics and social support, and physiologic and environmental variables affecting workplace health and performance.
Recognition of possible conflicts of advocacy regarding the employee, employer, work community and community at large.
Understanding of the use of occupational medicine, principles and the resident's own self care.

Knowledge

The resident should develop a knowledge of:

The relationship of the physician providing occupational care to:
1. Employees
2. Employers
3. The community
4. Other health care providers
Ethics and the role of the physician as:
1. Company representative
2. Worker's health advocate
3. Medical ombudsman
4. Medical recorder
Preplacement testing and examinations
1. General
2. Job-specific
Periodic health assessment as necessary
Disability determination and appropriate guidelines
Organ-related occupational illnesses
1. Lung diseases
  1. Reactive airway disease
  2. Pneumoconioses
  3. Infectious
2. Renal and urologic diseases
3. Skin diseases
  1. Primary irritant dermatitis
  2. Allergic sensitizers
  3. Photosensitizers
4. Liver diseases
5. Hemopoietic disorders
6. Central nervous system-related disorders, including special sense organs
  1. Eye
  2. Ear (e.g., noise-induced hearing loss)
  3. Peripheral neuropathy
7. Occupational Exposures and Pregnancy
8. Musculoskeletal disorders
  1. Postural/positional
  2. Other orthopedic problems
    1. Low back pain
    2. Carpal tunnel syndrome
  3. Trauma
Job-site related
1. Occupational hazards/exposures
  1. Allergens
  2. Animals
  3. Barotrauma
  4. Burns
  5. Electromagnetic fields
  6. Eye injuries
  7. Heavy metals
  8. Infections
    1. Human Immunodeficiency Virus infections
    2. Tuberculosis
    3. Hepatitis
  9. Noise
  10. Pesticides/herbicides
  11. Radiation/radon
  12. Sick-building syndrome
  13. Solvents/noxious gases/inhalants
  14. Thermal effects
  15. Violence
2. Temporal issues
  1. Violence
  2. Long hours
  3. Chronic fatigue
3. Ergonomics
  1. Repetitive trauma
  2. Work-station problems
4. Prevention
  1. Education
  2. Work environment modification
Psychosocial problems in industry
1. Employee assistance programs
2. Stress in the workplace
3. Concerns of disasters (e.g., fire, explosion, terrorism)
4. Harassment
5. Substance use disorders
  1. Alcohol
  2. Tobacco
  3. Prescription drugs
  4. Illegal drugs
6. Mental illness
Epidemiology and basic statistics
Legal issues in occupational medicine
1. Occupational Safety and Health Administration (OSHA)
2. National Institute for Occupational Safety and Health (NIOSH)
3. Worker's compensation laws
4. Local health care problems
5. Americans with Disabilities Act
Effects of over the counter and prescribed medication on job performance

Skills

Diagnostic
1. Ability to perform an occupational history
2. Performance of a job-specific physical examination
3. Drug testing
4. Recognition that common illnesses may have an occupational cause
5. Conducting a disability assessment
Management of industrial-related health care problems
1. Appropriate community/workplace protection
2. Treatment of hazards of the workplace
3. Rehabilitation programs
  1. Drugs
  2. Alcohol
  3. Psychologic
  4. Musculoskeletal
4. Basic laceration repair techniques and foreign-body removal
5. Joint injections, strapping techniques and other applicable techniques
6. Management of eye injuries
7. Pregnancy and pre-pregnancy issues
8. Evaluation of a patient with a specific chemical exposure
9. Determination of fitness to return to work/writing the return-to-work prescription
10. Counseling patients and employers about workplace safety

Implementation

Family practice residents should have exposure to occupational medicine and its concepts. This exposure can best be accomplished within the residency through the appropriate use of community resources. The guidelines may be established on a longitudinal basis or with an intense, in-depth experience, utilizing family physicians and other faculty of the residency program.

Resources

Zenz C, Dickerson, OB, Horvath, eds. Occupational medicine. 3d ed. St. Louis: Mosby 1994.

Guides to the Evaluation of Permanent Impairement. 5th ed. Chicago: American Medical Association, 2000.

Levy B. and Wegman, D. eds. Occupational Health: Recognizing and Preventing Work Related Disease and Injury. Fourth Ed. Lippincott, Williams and Wilkins. Jan 15, 2000.

LaDou,J. Occupational Environmental Medicine. Second ed. McGraw-Hill Professional Publishing. Jan 15, 1997.

Herzstein, JA et.al., International Occupational and Environmental Medicine. St. Louis: Mosby 1998.

Web sites

http://www.occupationalmedicine.com

American College of Occupational and Environmental Medicine
http://www.acoem.org

Published 11/84
Revised 10/90
Revised 07/96
Revised 06/02