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APPENDIX A Abstracts of Commissioned Papers THE ROLE OF THE PRIMARY CARE PHYSICIAN IN b:GALASPECTS OF OCCUPATIONAL HEALTH Nicholas A. Ashford This paper has two purposes. The first is to describe the nature and extent of the legal obligations of the primary care physician that are related to occupational health. The second is to discuss the opportunities for the primary care physician to assist both the worker and his or her employer in preventing or minimizing exposure to occupational health hazards and to assist the worker in obtaining compensation for occupational disease. The first purpose is primarily related to the discovery, reporting, and treat- ment of occupational disease. In a small minority of states, there is a statutory duty imposed upon all physicians to report an occupational disease to the public health authorities. There is no similar federal statutory requirement. There are adclitional duties, recognized in the common law (i.e., law developed through court cases), arising from medical practice. Failure to properly execute these duties could leave the physician liable in a negligence suit for malpractice. The duties imposed on a primary care physician acting as an individual's personal physician may be different from duties that arise when the medical practice is related to an individual's employment, (i.e., preemployment physical examina- iior~s, periodic physical examinations, or examinations undertaken for the purposes of medical removal, workers' compensation, or a third party lawsuit in tort). Duties to discover and report occupational disease are discussed at length in this paper. Referral to other specialists is a key element in contributing to the discharge of both the legal and ethical responsibilities of the primary care . . . pnyslclan. The second purpose of this paper focuses more on prevention and compen- sation. Federal and state laws empower and enable the indiviclual worker (and/ or his or her union) to utilize legal machinery to reduce the incidence and severity of occupational disease. This includes legislation for the control of toxic substances, right-to-know laws, antidiscrimination laws, and the worker's right to refuse hazardous work. Through a variety of laws, manufacturers and employers are directed to disclose or provide access to information regarding toxic substance exposure and the subsequent health effects to workers, to unions in their capacity as worker representatives, and to government agencies charged with the protection of the public health. The underlying rationale for these directives is the assumption that this transfer of information will prompt activity that will improve worker health. 78
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