Role of the Primary Care Physician in Occupational and Environmental Medicine (1988) / Chapter Skim
Currently Skimming:
The Cause for Concern: An Analysis of the Problem
The Cause for Concern: An Analysis of the Problem
Pages 15-28
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found no straightforward estimates of the extent of underreporting of occupational injuries in the BES annual survey data. In 1984, a congressional committee reported that "no reliable national estimates [of occupational disease]
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As a clinical specialty separate from occupational medicine, environmental medicine is in its infancy. Physicians primarily identified as occupational medicine specialists are often referred patients with environmentally induced ctisorclers.
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identified the clinical setting as an important site for achieving its goals to prevent occupational illness ancE injury. One objective stated that, "by 1990, at least 70 percent of primary health care providers should routinely elicit occupational health exposures as part of patient history and should know how to interpret the information to patients in an understandable manner." In its 1986 midcourse review, the DHHS (1936)
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The number of certified physicians in occupational medicine (a subspecialty of We American Board of Preventive Medicine) has remained relatively CQ~S.tant-~D recent years.
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This response can interfere with the often lengthy history taking that is required when all disease etiologies must be considered. Also, fear of alienating large corporate purchasers of care may encourage these prepaid plans to avoid the preventive aspects of occupational and environmental medicine particularly if they involve following up known or suspected hazards- and instead concentrate on quick turnaround services like preemployment examinations or evaluation of on-thejob injuries.
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A 1977-1978 survey of U.S. medical schools found that only 50 percent of them specifically taught occupational medicine as part of the required curriculum.
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meclical school. With rare exceptions, active medical school programs in occupational medicine have been the 14 programs that are part of the National Institute for Occupational Safety and Health Educational Resource Center (ERC)
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These overall barriers to the implementation of preventive services in the clinical setting also affect the ability and willingness of the physician to deliver occupational and environmental health services. In addition, occupational and environmental medicine bring their own special constraints to the arena of clinical practice PROBLEMS IN PRACTICE While physicians are always motivated to improve patient care, several practical problems may surface as they attempt to integrate occupational and environmental medicine into their practice.
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Primary care clinicians have little experience with health departments and are unlikely to consider them part of their normal support system. ECONOMIC ISSUES The economics of diagnosing and treating occupationally and environmentally mediated diseases may affect the primary care physician's willingness to get involved.
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Workers' compensation insurers and self-insured employers contest 60 to 80 percent of all long-latency occupational disease claims, denying that the conditions are work-related (Barth and Hunt, 1980~. In most states, contested workers' compensation claims are not paid by either insurer until this issue is resolved.
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Further, the duties imposed on a primary care physician acting in the role of a patient's individual physician may differ from those that arise when the care is related to the patient's employment for example, preemployment examinations or examinations conducted as part of a workers' compensation claim. In the context of primary care, a central question is whether the physician has a duty to take occupational and environmental histories.
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From page 26... ...
While it may seem inherently clear to primary care physicians that their primary obligation is to their patient, regardless of payment source, this perception is challenged when medical services are provided through agreements with employers. The issue of confidentiality is routinely encountered when physicians care for working patients, especially in the context of preemployment physical examinations and periodic medical screening programs.
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The inability to clearly and cleanly assign responsibilities greatly complicates the implementation of many recommendations made by this committee. Thus, a wide spectrum of factors exist that may limit the optimal participation of primary care physicians in occupational and environmental factors in the patient care that they deliver.
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n' }A 1~ - ~ ~_. ~ In, ~ Pitiable therefore is the lot of these workers, for since they very often have no other home than a small boat, when they fall ill they are obliged to go into a hospital, where it is impossible to enter on the precise and proper treatment for them unless the doctor knows clearly in what sort of occupation the patient is ertgaged.
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