Occupational History and Examination H.R.Sarreshtahdar, MD Occupational Medicine Specialist

Occupational history Symptoms Exposure Most important tool for the diagnosis of occupational illness Symptoms Exposure

Occupational history Problems: Important issues: Time constraints for workers and physicians Enormous range of known and potential toxic exposures Important issues: All jobs held and approximate date of employment Job title is not sufficient Significant changes in job duties Second job

Occupational history Exposure history Environmental history Have you ever worked with or been exposed to any of the following substances? Environmental history Water source, heating source, pets, proximity to industries, hobbies

Health in Relation To Work Relationship between symptoms and time of work shifts or specific exposures. Similar complaints among coworkers. Compensation

Patient Management The diagnostic period Formulation of treatment plans Communication Follow up

Types of examinations Pre-placement examinations Medical screening and surveillance examinations Return to work assessment Exit examinations Evaluation for specific occupational exposures or diseases Fitness for work assessment

Pre-placement examinations Most common and least specific. Assess a candidate’s suitability for a job. Need detailed description of the essential functions of the job. Do not easily exclude a worker from a job. Exclusion of the worker if he can not perform only essential functions of the job.

Surveillance examinations (Periodic) Screening tests are tools for secondary prevention In occupational medicine may be a tool for primary prevention Target-organ or substance-specific More focused than pre-placement examination Detect early disease Medical screening is not a substitute for hazard control

Return to work examinations Assess individuals before returning to work after a period of absence from: Occupational causes Non-occupational causes Assess fitness for work Need detailed information about job requirements An interaction between physician, industrial hygienist, ergonomist, and engineer to safely return the worker to the work.

Exit examinations Structure and content similar to periodic examinations Target-organ or substance specific The least common occupational examinations Shows any adverse occupational health effects before leaving the work

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