The Practice of Occupational

Medicine

Dr. Majid GolabadiOccupational Medicine

Specialist

2

Occupational and environmental medicine is

the medical specialty devoted to prevention and

management of occupational and environmental

injury, illness, and disability; and promotion

of health and productivity of workers, their

families, and communities.

3

Occupational Medicine:Occupational Medicine:The Beginnings – Ancient TimesThe Beginnings – Ancient Times

The history of occupational medicine can be traced into antiquity. Observations of increased rates of illnesses and mortality among miners date back to Greek and Roman times.

4

Occupational Medicine:Occupational Medicine:Laying the Foundation – BauerLaying the Foundation – Bauer

15561556

Georg Bauer publishes De re metallicus, a discussion of the dangers and diseases of miners

5

Occupational Medicine:Occupational Medicine:The Beginning – RamazziniThe Beginning – Ramazzini

17001700

Bernardini Ramazzini publishes first edition

of Diseases of Workers

6

Occupational Medicine:Occupational Medicine:The Modern Era – OSH Act of 1970The Modern Era – OSH Act of 1970

In 1970, Congress passed the Occupational Safety and Health Act (OSH Act), creating the:

• Occupational Safety and Health Administration (OSHA)

• National Institute for Occupational Safety and Health (NIOSH)

• Occupational Safety and Health Review Commission (OSHRC)

Location of Occupational

Illnesses & Injuries amongLeading causes of

Morbidity & Mortality in…

5Nearly half of all injuries in some age groups !

Occupational Fatalities Ranking

8

Financial Costs of

Occupational Illnesses &

InjuriesExceed $250 billion per year

The Human Costs

Staggering!!?

The ILO estimates that : The World’s Work Force suffers More than 1 Billion Accidents Every Year.

Over 2 million People are killed by Their Work Every Year.

More than 6% of National Incomes

Cause Permanent Disabilities &

Economic Losses

The WHO estimates that : There are at least 250 million Cases of Occupational Disease Worldwide!!! with an Unknown additional toll on National Incomes !?

How much of all injury cases result

in Loss of Work ?

One- third

What is the most common

Occupational Respiratory Disease

?

Asthma

How muchof new-onset

Asthma in adults is Work-related ?

20%

How many Chemicals are found in Work Settings?How many Workers are exposed to these Substances?Many Millions

More than Half a Million

Workplace Exposure to Carcinogens

All Cancer Cases5-10 %

Less than 0.1% of cancer patient ever receive any settlement from employers !!!

How many Lung Cancer Cases in Men & Women are Work-related?16-17 %

2%

Occupational Cancers are

Totally Preventable !!!100

%

Work Health

Case 1: The Hazards of Work 

A 31-year-old laboratory technician is referred to your clinic by her manager, because of alleged lateness and poor performance at work. You are asked to assess whether there is an underlying medical cause for this.

 She tells you that she has not been sleeping well lately, possibly due to nocturnal

coughing. She says the lab is cold and drafty, and that by the end of the working day her right arm is aching. She says that when she told her manager, he was unsympathetic; telling her she should leave if she doesn’t like the job.

 1. What are the presenting medical problems?  2. What are the possible work-related causes of her symptoms? 3. What are the potential hazards in her workplace and how might you classify

them? 4. How will you respond to the manager’s questions?

Worker

Workplace

O.M O.H

Industrial or Occupational

Hygiene

Anticipation Recognition Evaluation Control Of Health Hazards arising in or

from the Workplace

Occupational Medicine

Practices in Occupational medicine

• Occupational Medicine focuses on the prevention,

evaluation, treatment and resolution of health conditions

caused by the workplace environment.

Case 2: Is it work-related?A 58-year-old hospital porter has been off sick for almost a year, with low back

pain. He says he injured his back at work. His back pain has not improved with physiotherapy and analgesia. He has difficulty walking up and down stairs and is breathless on exertion. His occupational history is as follows:

     Left school at 15    Had numerous labouring jobs in the construction industry for 20 years      • Worked on a tunnelling project for 18 months    Worked as a lorry driver for a brewery for 8 years     Worked as a hospital domestic assistant for 2 years     Has been employed as a hospital porter for 11 years 

1.  What occupational hazards might account for his breathlessness?

 2. How would you assess whether his symptoms are work related or not?

 3. What are the possible causes of his back pain?

 4. What advice would you give him?

 5. Is he likely to be return to work?

 6. What work might he be able to do?

Occupational Physician must :Determine that an injury or illness is caused by work,

Diagnose it,Treatment,Assess the extent of impairment, &

Assess the ability of the worker to resume work.

Occupational Medicine Services

Preventive ServicesCurative Services Rehabilitative Services Consultative Services Administrative ServicesResearch ServicesEducational & Training Services

& Others

Levels of Prevention

Primordial PreventionPrimary PreventionSecondary PreventionTertiary Prevention

32

Occupational and environmental medicine is the medical specialty devoted to prevention and management of occupational and environmental

injury, illness, and disability; and promotion of health and productivity of workers, their

families, and communities.

Primary Prevention at an Organizational LevelSubstitution of a Less Hazardous

Process for a More Hazardous One

Substitution of a Less Hazardous Substance for a More Hazardous One

Installation of Engineering Controls & Devices

Job Redesign, Work Organization Changes, & Work Practice Alternatives

Primary Prevention at an Individual Level

Education

Personal Protective Equipment

Administrative Measures

Secondary Prevention of

Occupational IllnessScreening for Occupational Disease

Screening at-risk Workers who are not Covered by Standard-mandated Examination

Tertiary Prevention of Occupational

IllnessPrevent DisabilityPrevent Further Progression

Health Examination

Programs

1-Preemployment H.E. or

Preplacement H.E. ?

The Objectives of the Preplacement Health

Exam. (Employment Entrance

Examination)

Case 3: Assessing fitness for work

 A 29-year old HIV positive doctor has been offered a post on an

anaesthesia rotation.

 1.   Is it relevant to know how HIV was acquired? 2.   How will you assess whether s/he is medically fit for the job? 3. What information will you need, to make a fully informed

assessment?

A Model Framework for Assessment of Medical Fitness for Work

Person•Relevant medical history

•Functional capacity (physical/psychological)

Job•Demands/requirements

•Safety critical work•Hours, travel etc

Risks•Employee•Employer

•Colleagues•3rd parties

(customers/service users/public)

Fitness for

Work

2- Periodic Health Examination

General Specific (Hazard-

related)

The Objectives of Periodic Health

Exam.

3- Other Mandatory Health Examinations

Return-to-Work Examination

a- Postinjury

b- PostillnessMotor Vehicle Operator ExaminationLocomotive Engineer ExaminationPhysical Fitness ExaminationFlight Personnel ExaminationJob Transfer ExaminationDisability & Retirement ExaminationForeign Travel Examination (prior to)