FITNESS FOR WORK

Is Fitness For Work The Same As Fitness To Be Employed?

WHY ASSESS FITNESS FOR WORK? From The Medical Point: Certain medical conditions could result in accident Some medical conditions can be aggravated by work exposures Some work exposures could result in illness pr increase the risk of illness e.g lung ca associated asbestos exposure. Smoking increases the risk in an almost multiplicative manner.

WHY ASSESS FITNESS FOR WORK? From the employers view point: Safety reasons Health reason To control cost of medical care especially for companies that provide in-house medical coverage. Productivity

WHO TO PERFORM FITNESS FOR WORK / EMPLOYMENT A medical practitioner Trained in occupational health and to be familiar with hazards at work and the relationship between hazard exposure and illness.

EXAMINATION TO DETERMINE FITNESS FOR WORK Pre-employment Pre-placement Return to work medical after prolonged illness or injury Medical Surveillance Periodic Medical Examination

WHO TO DETERMINE CRITERIA FOR EMPLOYMENT? -Employer Or Doctor?-

WHAT MEDICAL CONDITIONS TO CONSIDER Acute medical conditions Chronic medical conditions Surgical conditions Psychiatric conditions Physical disabilities

ACUTE MEDICAL CONDITIONS-INFECTIOUS ENT (Otitis, Sinusitis) Hepatitis Respiratory Tract Infection Including Pulmonary Tuberculosis Urinary Tract Infection

ACUTE MEDICAL CONDITIONS-NON INFECTIOUS Cardiovascular Pulmonary Gastro intestinal tract Genito-urinary tract Musculo-skeletal system Temporary unfit until the condition is addressed

CHRONIC / MEDICAL CONDITIONS Blood & blood forming organs Chronic Obstructive Lung Disease Asthma Cardiac conditions + Hypertension Endocrine (diabetes, thyroid) Renal

CHRONIC MEDICAL CONDITIONS-CONTD. Musculo-skeletal conditions Malignancies Neurological conditions Gastro-intestinal tract including liver.

SURGICAL CONDITIONS Cholithiasis Renal stones Hernias Ruptured tympanum Prolapsed intervertebral disc Lumps and bumps Temporary unfit until them surgical condition is addressed

PSYCHIATRIC CONDITIONS Depressive illness Obsessive compulsive disorder Schizophrenia Phobias Would you consider applicants to be FIT?

PHYSICAL DISABILITIES Visions Deaf Amputee How do you decide on these cases?

LAB INVESTIGATIONS Vital Signs Urine FEME Complete blood count + ESR Serum biochemistry LFTs Renal function

LAB INVESTIGATIONS-CONTD. Hep B & HIV Screening Drug Screening Vitalograph Audiogram Pregnancy test Chest X-ray ECG To be performed with consent

ETHICAL ISSUES WITH PRE-EMPLOYMENT MEDICAL EXAMINATION. When conducting pre-employment medical exam., doctor is the agent of the employer. The normal doctor-patient relationship does not apply. Most of job applicants are not regular patient. The examining doctor need to be professional and to give his recommendation without fear or favour.

FOMEMA EXAMINATION In this a pre-employment examination? Who request for the examination? Who benefits from the examination?

MEDICAL CERTIFICATION For “light duties”. What does “light duties” means? To stay away from work. What are the criteria? Who determines whether a worker can continue with work?

RETURN TO WORK AFTER ILLNESS Seldom carried out Important as a worker need to phase in gradually to his/her normal job after a period of absence. This is the best carried out by an OHD who is familiar with the job demands.

What Is The Legal Position Recommends An Applicant Of a Doctor Who Recommends An Applicant is UNFIT for employment?

DOCTOR OWED NO DUTY OF CARE TO JOB APPLICANT BMJ 4 April 1998 “ Occupational Health Physicians Who Advise Employers Not To Hire A Job Applicant On Medical Grounds Cannot Be Sued For Negligence By th Job Seeker, The Court Of Appeal Ruled Last Week.” THE CASE: 42 yr Old West Indian Woman With Sickle Cell Anemia Applying For A Permanent Cashiers Job. At That Time She Was Working As A Temporary Cashier. She Disclosed In A Medical Questionnaire That She Was Absent For One 5 Week Period Due To Sickle Cell Anemia And Chest Infection. At Some Time She Had Had Asthma. The Medical Adviser Who Did Not See The Applicant Advised The Company Not To Take Her On A Permanent Staff On The Basis Of The Questionnaire

SUMMARY Criteria for Employment Fitness For Work And Employment Medical Classification To Be Considered Types Of Medical Examination Legal Standing Of A Doctor In The Process Of Determining FITNESS For Employment.