Occupational Medicine Practice Research Articles

Beliefs about and use of occupational medicine practice guidelines by case managers and insurance adjusters.

Workers' compensation case managers and adjusters have increased their use of practice guidelines recently, partly in response to state regulations. However, informally reported rates of use are not as high as desired for the best managed care practices and the greatest reductions in lost work time. Although there are several studies of physicians' use of guidelines, there are few if any studies about case managers' and adjusters' beliefs about, and utilization of, either general medical or occupational medical practice guidelines. Information about attitudes, beliefs about practice guidelines, and actual use should help developers make the guidelines more usable and bring about more effective interaction among case managers, adjusters, treating physicians, and other health professionals. This article reports on pre- and post-training surveys of a cohort of case managers and adjusters who participated in a case-based guideline training course. It then compares their responses to those of the physicians whose cases they might manage.

Occupational and environmental medicine in Colombia.

Colombia is a country rich in natural resources, with a steadily developing economy. Occupational and environmental medicine (OEM) education and practice have developed relatively recently in Colombia, mainly in response to a series of long overdue (and still partially implemented) reforms to the health care, social benefits, and education systems. Expansion in general and occupational health coverage of the Colombian population and development of OEM education and training were to be achieved through a clear stimulus to private sector initiatives. Despite some measurable overall progress, the goals remain elusive. This article discusses several aspects and the perspectives for further development of the specialty in this country, in the context of the socioeconomic factors involved in that process.

Education for the Practice of Occupational Medicine: Knowledge, Competence, and Professionalism

The multistep process of education is delineated by the sequential phases: (1) Knowledge Transfer, (2) Competence Development, and (3) Professional Inculcation. The realities of practice modes and curricular time constraints are important determinants of the breadth and depth of the information provided in the Knowledge Transfer process. Accordingly, it is proposed that Phase 1, the Knowledge Acquisition Process, be organized into two components: (1) Core Knowledge, requiring both significant breadth and depth; and (2) Augmentive Knowledge, providing wide breadth and appropriate but variable depth. This curricular organizing proposition recognizes that: (1) the wide breadth of multiple stores of knowledge inherent in the practice of PM and EOM considerably exceeds many other medical specialities; (2) the duration of training is inherently shorter; and (3) its practitioners generally operate as members of teams consisting of other professionals (e.g., attorneys, engineers, business administrators, industrial hygienists, sociologists, psychologists). Obviously, it is unreasonable to expect the members of such teams to each have comparable depth and breadth of knowledge. A broad knowledge base, implicit in Augmentive Knowledge, provides the capacity for recognition, understanding, and application of capabilities brought by other professionals. Facilitating communications between team members, each possessing a broad knowledge base, enhances the effectiveness of the knowledge, competence, and professionalism of collaborative efforts. Phase 2, Competency, consists of the coherent integration of multiple stores of information applicable to the management of a clearly defined task with a clearly measurable outcome. The accomplishment of true competency is not based on the simple possession of multiple stores of knowledge; rather it depends on the facility and effectiveness with which information bases are marshaled, integrated, and communicated. Clearly, the effectiveness of this process increases with its interaction; it is unreasonable to expect a significant degree of competence immediately upon graduation from a training program. Phase 3, Professionalism, and its basic ethos provides the governing context for the sound application of competencies. Although it is difficult to teach, only with its accomplishment can the educational process be considered whole, albeit never complete.

State licensing laws and the interstate practice of occupational medicine.

In 1996, the Occupational Health Law and Policy Section of the American College of Occupational and Environmental Medicine (ACOEM) was asked to undertake a study of state licensing regulations after the prosecution of an ACOEM member for practicing medicine without a license. In response to that member's experience, the ACOEM House of Delegates passed a resolution asking the College to lobby individual states for an exclusion to their licensing acts for occupational and environmental physicians. Recognizing the tremendous obstacles to this task, the ACOEM Board of Directors then referred the issue to the Occupational Health Law and Policy Section for further study and analysis. What follows is a report of that study, including the results of a survey mailed to the licensing authorities of the 50 US states and four US territories. The results of this study are not meant to offer advice to College members regarding compliance with specific state licensing regulations, nor does it define the official position of the states that responded. States that responded were careful to disclaim their responses as the official position of their states' agencies and were assured that the responses were provided for informational purposes only. The purpose of the survey was not to provide information for reference but simply to identify general trends and document the various positions that states may take on certain licensing issues.

Auditing occupational medicine.

An important challenge facing the quality of practice in occupational medicine is a limited evidence-base, but equally important is the need to translate good evidence into high quality practice. Audit has an important role to play in addressing the determinants of variations in practice. Furthermore where the evidence is good enough to permit the development of valid practice guidelines, audit may help in improving education and standards of practice. External audit may have a role to play in ensuring conformity with service-level agreements and especially in addressing issues of quality which some management systems may fail to address. As more literature is published reviewing and achieving a consensus on the evidence-base for the practice of occupational medicine, and as more experience in audit is described, it can make an important contribution to quality in occupational medicine.

Military parachuting injuries: a literature review.

This article is a literature review of the aspects of military parachuting related to occupational medicine and focuses on 'conventional' military static line parachuting using a round parachute. The analysis of injuries resulting from military parachuting provide an excellent example of military occupational medicine practice. The techniques of military parachuting are described in order to illustrate the potential mechanisms of injury, and a number of 'classical' parachuting injuries are described. Finally some recommendations are made for the recording of parachute injuries which would assist in the international comparison of injury rates and anatomical distribution.

The renewed mission of the occupational physician: to be or not to be a doctor?

A recent editorial pointed out that the 'adding-value' feature of occupational physician (OP) activity as compared to allied professionals in preventing occupational risks is the clinical skill. It was argued that, apart from clinical skills, no difference exists between the risk manager and the OP in dealing with risk characterization and risk management. On the other hand, it is stressed that the practice of occupational medicine must be based on a sound professional competence including a basic clinical knowledge. Should the educational process of the specialist in occupational medicine include the acquisition of adequate clinical competence? Several reports dealing with education and training of OPs in Europe underline the need that this figure be a skilled clinician. This is necessary to investigate the occurrence of occupational and work-related diseases and to evaluate and control health status of workers who might be exposed to harmful factors.'' Elsewhere clinical skills are less emphasized'' or neglected. Outside Europe, the American College of Occupational and Environmental Medicine states that the mission of the OP is devoted to the prevention and management of occupational and environmental injury, illness and disability, promoting the health and safety of individuals and focusing diagnosis of illnesses and their rehabilitation.

Occupational Medicine Practice Guidelines, Evaluation and Management of Common Health Problems and Functional Recovery in Workers

Journal of Occupational & Environmental Medicine: October 1997 - Volume 39 - Issue 10 - p 1013-1014

Characteristics of Occupational Medicine Practitioners and Practice in Canada

To obtain baseline information with respect to occupational medicine practice in Canada, a questionnaire survey of members of the Occupational and Environmental Medical Association of Canada was carried out by mail in 1993. One hundred eighty-six responses were received (56% of the membership). The average age of the respondents was 49.5, 12% were female, and 55% worked full-time in occupational medicine. Practice types included corporate settings (58%), clinics (23%), government agencies (14%), worker's compensation boards (7%) and academic settings (5%). Sixty percent had some formal training in occupational medicine, and 46% had occupational medicine certification by either the Royal College of Physicians and Surgeons of Canada, the Canadian Board of Occupational Medicine, or the American Board of Preventive Medicine. Younger physicians were more likely to be female and have gone directly into occupational medicine. Women were more likely to be working full-time in occupational medicine but worked fewer hours per week. Those physicians with specialty qualifications were older and more likely to be working full-time in occupational medicine and be active in professional activities. The Association intends to continue surveying its members on a triennial basis, identifying trends in the practice profiles and continuing education needs.

Ethical issues in occupational medicine practice: knowledge and attitudes of occupational physicians.

Views on ethical conduct in occupational medicine practice can vary from country to country and even between occupational health practitioners. However, there are many areas of common agreement, and this is apparent on comparing guidance documents on ethics produced by several different organizations. The usefulness of these documents will depend in part on how aware practitioners are of their existence. A standardized questionnaire administered to 70 occupational physicians in the Netherlands, UK, and Singapore showed that there was a lack of awareness of guidance documents on ethics, even for publications from their own countries. Only five of the 70 respondents consulted an ethics document in the past year. In addition to publications, other avenues were used for advice on ethical issues. There was a difference in opinion between the physicians from Singapore and those from the two European countries on whether specific occupational health activities were ethical. These findings reinforce the need for international guidance on ethics to take into account differences in attitudes and practice between countries. On many issues there was no unanimity of opinion, even between occupational physicians from the same country. This may be an indication of the complexity of ethical matters, and provides a rationale for publishing guidance on ethics in occupational medicine.

The changing role of the occupational physician in the private sector: the Canadian experience.

The role of the occupational physician in the private sector is changing. Fewer large corporations maintain medical departments following the 'downsizing' trend of the late 1980's and early 1990's and those that do have extensively redefined the duties of the corporate medical director, often extending these duties to include responsibility for environmental health. Occupational medical services for employees previously covered by in-house services are now often provided by outsourcing. The private practice of occupational medicine has become the major growth area of the specialty in both the US and Canada. These trends have been driven primarily by economic imperatives and new management philosophies; the trend may have gone too far and a 'rightsizing' correction may be in progress. However, it is not clear that corporations in general are deriving the greatest value they can from their physicians or that the current generation of senior managers is utilizing its health professionals as effectively as they might. This is in part because the training, qualifications and capabilities of occupational physicians are not well understood. At least as important, however, is persistent confusion over desirable and appropriate roles that obscures the potential contribution of the medical professional within a management structure. We suggest that the greatest value in occupational medical services may be in the anticipation of risk related to health issues and the flexibility this gives the organization to manage the problem.

A Survey of Travel Clinics Throughout the World

Background: The growth of travel medicine as a specialty has been marked by a dramatic increase in the number of travel clinics worldwide. A survey was conducted of travel clinics to assess the current practice of travel medicine. Methods: A questionnaire was sent to members of the International Society of Travel Medicine, asking questions about clinic demographics, categories of advice given and immunizations available, and educational training of clinic personnel. Results: Responses from 341 clinics were analyzed; 57% were located in the United States; 21% in Europe; 6% in the United Kingdom or Ireland; 6% in Canada; and 11% from other areas of the world. Most clinics were private (41%); however, many other affiliations were represented, including schools of medicine (20%), hospitals (10%), and occupational medicine and student health practices (10%). The median number of patients seen per year was 750; however, the range was 6 to 50,000. Each clinic offered many vaccines, and advice for the prevention of malaria, diarrhea, and insect avoidance was given over 95% of the time. Providers of advice were nurses (57% of the time) and physicians (83%); however, in the United States nurses gave advice independently more frequently (22% vs. 8%, p <.001) than in other parts of the world. Clinics also frequently gave telephone advice (15% charged for this service) and evaluated ill returned travelers. Over 60% of physicians had trained in infectious diseases and/or tropical medicine, although there were training differences between regions of the world. Conclusions: Travel clinics throughout the world demonstrate similarities as well as differences in practice. Defining these will help in determining practice needs in the growing field of travel medicine.

Managing health and safety in hospitals.

This article is set against the background of recent changes in health and safety legislation which directly affect hospital staff. Research into the central concepts of hazard, risk and harm is contributing to a broader understanding of the management of health and safety. Both occupational medicine and safety practice must recognise the role of psychosocial and organisational processes in managing workplace hazards.

Occupational physicians and their work: prospects for audit.

An anonymous postal questionnaire was sent to 200 occupational physicians in the UK to determine their activities, the nature of the organizations within which they work and their attitudes and practices with respect to audit. One hundred and sixty-six physicians responded to the questionnaire, of whom 119 (72 per cent) were currently practising occupational medicine. Fifty-seven (48 per cent) of these 119 were engaged in some form of audit but only 21 (18 per cent) were engaged in an audit of structure, process and outcome. Assessment of continuing fitness for work or sickness absence ranked first overall with respect to the proportion of the physician's time engaged. The study revealed a wide diversity in the organization of the practice of occupational medicine, in the qualifications of occupational physicians and in their participation in audit. Needs for the development and wider implementation of methods of audit in occupational medicine have been identified by the study.

Peter Holland: a pioneer of occupational medicine.

The earliest recorded occupational health service in this country was that established in a cotton spinning factory at Quarry Bank Mill in Cheshire. The mill was built in 1784 by Samuel Greg and his partners. They employed local labour and also some parish apprentices. Happily, Samuel Greg was a good christian and, having created a modern factory and a model village with a church and a school, he was equally concerned for the physical welfare of his employees. Accordingly, he appointed a doctor to make pre-employment examinations of the apprentices and to visit regularly to deal with the health problems of a community of some 400 people. The man he chose was Peter Holland of Sandlebridge, who had served his medical apprenticeship under Dr Charles White of Manchester. The first record of the employment of a doctor was in 1796, but from 1804 to 1845 (doubtless in response to the early factory legislation) each visit of the doctor was entered in a day book with either an indication of fitness to work or details of the treatment required. The complete record consists of two hardback foolscap notebooks that provide a fascinating insight into the medical practice of the times when the industrial revolution was just getting under way. One of the more interesting features is the preservation of medical secrecy. Dr Holland made his comments on the case in shorthand and his instructions in longhand. By a fortunate coincidence the key to the shorthand was discovered and this has now been largely transcribed. Although much of the content of the diaries is the day by day practice of medicine at the time, there are many illuminating glimpses of the early practice of occupational medicine.

Ethical Conflict in the Private Practice of Occupational Medicine

From the Boston University Medical Center, Occupational Health Program, 88 East Newton St., Boston, MA 02118–2393 (Dr McCunney); and the Division of Environmental Sciences and the Department of Medicine, Columbia University, New York, NY (Dr Brandt-Rauf).

Implications for the use of TLVs to clinical occupational medicine practice

Implications for the use of TLVs to clinical occupational medicine practice

Ethical Issues in Occupational Medicine Practice: An Overview

Ethical Issues in Occupational Medicine Practice: An Overview

Occupational Health Services: A Practical Approach

medicine provides not only an intellectual challenge and a professionally stimulating branch of medicine, but administrative and managerial challenges as well. Dr Guidotti and his coauthors have produced a text that addresses the latter while leaving the former for others. No other text has accomplished this task as well. book serves as a guide through the maze of issues that may entrap any physician planning to enter the practice of occupational medicine, either fully or shared with other clinical activities. A physician may enter this maze unfamiliar with its complexities, nuances, or consequences. path is suggested by the section headings selected by the authors: The Health Care System, Occupational Health Care Delivery, Office Administration, Program Management, and Occupational Health Services. stated objective of the book is to provide general guidelines for creating, developing and managing a sound program of high quality occupational health care delivery....

Developing a Specialty Occupational Medicine Practice

Developing a Specialty Occupational Medicine Practice