PREVENTIVE MEDICINE

OCC HEALTH
OCCUPATIONAL MEDICAL HISTORY TAKING AND WORK Lecture 1.2

FITNESS ASSESSMENT
Maria Theresa R. Torres-Cosme, MD,MOH,DPAFP, FPAFP | September 19, 2019

NOTE • Presence of similar symptoms among co-workers with the

All notes taken from Dra. Cosme’s ppt same type of job and exposures
Notes with *** were emphasized/mentioned as “must- • Evaluation of non-work exposures
knows” • Presence of control measures
CASE
CONTENT OF A MEDICAL ASSESSMENT
• Gardo, is a 40 year old male
• Major Illnesses
• CC: Shoulder pain
• Surgical procedures
• HPI: 1 week prior to consult, he started right shoulder pain mild
• Medications used
in intensity precipitated by movement. No medications taken
• Allergies
• 3 day prior to consult, he noted an increase in pain severity from
• Trauma
mild to moderate and experienced radiation of the pain to the
right arm. • Family Health histories
• Occupational History: He works as a construction worker in a • Health Habit histories
condo project. • Immunization Histories
• Reproductive histories
APPROACH TO PATIENT
• HISTORY - Occupational history is the most neglected MEDICAL EXAMINATION
• P.E. - signs and symptoms may be specific but often most • Vital Signs
general and non -specific • Visual Acuity / Color Vision
• LABORATORY - CXR; Pulmonary function testing; Blood and • Dermatological Systems
Urine evaluation • Ears, eyes, nose, mouth and throat.
• Cardiovascular system.
EPIDEMIOLOGIC CRITERIA FOR CAUSALITY *** • Respiratory system.
• Temporality • Gastrointestinal system.
− When in relation to the exposure do/did the • Endocrine and metabolic system.
symptoms start? • Genitourinary system.
− Considered from the time of exposure to onset of • Musculoskeletal system.
symptoms • Neurological system.
• Reversibilty
− Do these get better or worse on any day of the week LABORATORY TEST
or go away on weekends or vacations? • Complete blood count
• Exposure-response • Urinalysis
− Are the symptoms especially worse when • Chest X-ray
undertaking task or in areas with high exposures? • The following tests are to be performed if clinically indicated
− Directly proportional to the exposure of the px and if work exposures require these tests to be done to
• Strength of association establish baseline data:
− Do any other persons where you work have similar –Liver function
symptoms? –Renal function
• Consistency –Pregnancy test for female applicants
− Reports of the same symptoms/same exposure –Audiometry
• Specificity –Spirometry
− Other exposures or causal factors • Based on company policy (test done with informed consent)**
• Analogy –Drug Screening
–Hepatitis B profile
− Same symptoms/similar agents
–HIV antibodies
• Biological plausibility
–Neuro-psychological testing
− Symptoms compatible with mechanism of disease
NON-OCCUPATIONAL EXPOSURES
KEY SCREENING QUESTIONS
• Tobacco smoking
1.What type of work do you do?
• Excessive alcohol use
2.Do you think your health problems might be related to your
work? • Recreational activities, hobbies, unpaid work (e.g., home
3.Are your symptoms different at work and at home? renovations)
4.Are you currently exposed to chemicals, dusts, metals, radiation, • Drug use are other potential sources of hazardous exposure.
noise or repetitive work? Have you been exposed to chemicals,
dusts, metals, radiation, noise or repetitive work in the past? WORK FITNESS ASSESSMENT
5. Are any of your co-workers experiencing similar symptoms?
UNFIT APPLICANT
ELEMENTS OF THE OCCUPATIONAL HISTORY • The term medically “unfit” refers to the failure to meet the
• List of jobs specific inherent requirements of an occupation due to the
• Exposures presence of a medical condition that is an exclusion for the
relevant occupation, or due to a lack in the capacity (physical
• Type
or mental) to perform the work, to the required standard.
• Assessment of dose
• Timing of symptoms in relation to work

Trans 1.2 Transcribed by: Claire Trinidadqt 1 of 2

 PREV MED Occupational Health: Medical History Taking and Work Fitness Assessment 2 of 2

• This applies to many chronic mental and physical conditions At the completion of the examination, the applicant shall be
and shall be declared UNFIT unless these conditions are rated as follows: ***
reversible. • CLASS A
• Unfit: This category describes the employee who is unable to – Physically fit for any work
perform the job without being a hazard to self or others.
• Subcategories *** • CLASS B
• "Temporarily" means that the medical condition(s) may - Physically under-developed or with correctible defects,
improve with time, thus allowing return to work or (error of refraction dental caries, defective hearing, and other
transfer to some other job. (after recovery -> fit to work) similar defects) but otherwise fit to work.
• "Permanently" usually means that the employee will
never be fit for the job and that no modification of the • CLASS C
working conditions is reasonably possible or medically -Employable but owing to certain impairments or conditions,
relevant (heart disease, hypertension, anatomical defects) requires
special placement or limited duty in a specified or
TEMPORARILY UNFIT selected assignment requiring follow-up treatment/periodic
• Acute condition evaluation.
o medical
o surgical • CLASS D
• They remain in this category until the condition is cured. -Unfit or unsafe for any type of employment (active PTB,
• Following their recovery, the job applicant is to be reassessed advanced heart disease with threatened failure, malignant
to ensure that full recovery has taken place. hypertension, and other similar illnesses).
• If recovery is complete, the candidate is now declared as FIT.
PERIODIC ANNUAL MEDICAL EXAM
JOB APPLICANTS WITH PHYSICAL DISABILITIES • To follow-up previous findings
• The suitability of job applicants is to be determined by the job • Allow early detection of disease
requirements and the safety risk associated with the job. • Determine effect of exposure to health hazards
• Example: • Checking the effectiveness of preventive and control
–Monocular vision measures
–Low vision • Includes general examination and special investigations
–Color deficient (ex. for seamen) (biochemical monitoring)
–Deaf • Shall have an interval of not longer than one year between 2
consecutive PE
JOB APPLICANTS WITH DEFORMITY AND/OR AMPUTATION
OF LIMB(S) TRANSFER EXAMINATIONS
• A job applicant with deformity or amputation of a limb to such • When a worker changes his job, the occupational physician is
a degree that the deformity or amputation interferes with required to certify that the worker is fit to carry out new duties
successful and safe performance and emergency evacuation • Applicants examined for employment and accepted for
is declared UNFIT. specific work or job shall not be transferred to another work or
job until they have been examined by the physician and
OCCUPATIONAL HEALTH EXAMINATIONS certified that the transfer is medically advisable
HEALTH EXAMINATIONS
• Entrance SPECIAL EXAMINATIONS
• Periodic Special examinations may be required where there is undue
• Special examination exposure to health hazards such as lead, mercury, hydrogen
• Transfer examination sulfide, sulfur dioxide and other similar substances
• Return-to-work
• Separation from work examination RETURN TO WORK EXAMINATION
• Determines the workers' suitability for the job
PRE-EMPLOYMENT/ PRE-PLACEMENT • Recommends appropriate actions to protect them against
• Requirements for applicants: future exposures
• Job qualifications, • Identifies if there is a need for a reassignment or a special
• Job related experiences, rehabilitation
• Personal attributes
SEPARATION FROM EMPLOYMENT EXAMINATION
• Passing the pre-employment medical examination.
• To make a final evaluation of workers' health, compare it with
• Pre-employment medical fitness assessment is left to the
previous medical examinations
discretion of the doctor who is usually not provided with
any form of guideline. • To assess how the prior job assignments may have affected
their health.
• The interpretation of “Fitness” is left entirely to the doctor.

ROLE OF PHYSICIAN REFERENCES

• Must display professional attitude, competence, Forastieri,V. OCCUPATIONAL HEALTH SERVICES AT THE
objectivity and receptivity WORKPLACE. Programme on Safety, Health and the
• Professional Secrecy Environment, International Labour Organization (ILO)
-The MD send report to the employer only on the subject of END OF TRANSCRIPT
fitness to work Transcribed by: Claire Trinidadqt
• Professional Independence***
-Reject any external attempt to influence his assessment or
opinion
-Display strictest objectivity in his approach and be ready to
justify his opinion