1. FITNESS
FOR WORK

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

3. 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.

4. 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

5. 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.

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

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

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

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

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

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

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

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

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

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

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

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

18. 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.

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

20. 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?

21. 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.

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

23. 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

24. 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.