Role of the Primary Care Physician in Occupational and Environmental Medicine (1988) / Chapter Skim
Currently Skimming:
Goals and Interventions for Clinical Practice
Goals and Interventions for Clinical Practice
Pages 29-46
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From page 29... ...
· Call known or suspected hazards to the attention of public health agencies or other entities as indicated by the history and information obtained. Primary care physicians with a special interest in occupational and environmental medicine, or whose practices include a number of patients with those 29
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From page 30... ...
These greater levels of participation could not be expected of all primary care physicians, but the committee feels that at least the minimum amount outlined here should be expected of all of them PN ~ ~RVENTIONS As described in Chapter 2, primary care physician involvement in occupational and environmental medicine is hampered in a number of ways. The health care delivery and public health systems do little to facilitate physicians' involvement; clinically useful information and accessible support systems are lacking; and economic, legal, and ethical matters sometimes present formidable constraints.
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From page 31... ...
In its deliberations, the committee was hampered by the paucity of information about the practice patterns of primary care physicians vis-a-vis occupational and environmental medicine. Although its meetings with small groups of primary care practitioners were helpful, the committee quickly recognized the need for a broad and systematic survey of primary care physicians' needs and concerns in this area.
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From page 32... ...
For example, an emergency room resident might call a local internist with known expertise in occupational and environmental medicine for help in dealing with a patient with a possible pesticide exposure. Even if primary care practitioners with special interest in occupational and environmental medicine could address the most immediate requests for local and informal consultation, a secondary need for more formal consultation would remain.
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From page 33... ...
Local community organizations such as Coalitions for Occupational Safety and Health and nonprofit groups organized around specific environmental issues, volunteer organizations such as the American Lung Association and the American Cancer Society, and, perhaps, existing social service agencies could also help in this capacity. Some of these organizations would require support to add staff to handle these types of patient-centered services.
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From page 34... ...
The committee feels that a single-access center, perhaps established on a state or regional basis, will most effectively serve the occupational and environmental medicine needs of primary care physicians. Available to all physicians by telephone, and itself a center of expertise in occupational and environmental medicine, the single-access center must be able to respond at many different levels, ranging from a simple telephone consultation on specific technical issues to requests for advice regarding available services for the comprehensive management of large-scale occupational and environmental problems.
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From page 35... ...
Practice-based Information Resources Primary care physicians are more likely to consult reference materials if they are accessible and easy to use. Several bibliographies of occupational and environmental medicine have been published (American Medical Association, 1981, 19~34~.
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From page 36... ...
It is, therefore, imperative that the developing expert systems include, when appropriate, the dimensions of occupational and environmental medicine. Systems that relate clinical signs and symptoms to occupational and environmental exposures would be most useful to primer' care physicians in establishing a differential diagnosis.
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From page 37... ...
and appropriate professional agencies mobilize efforts to explore and initiate means of correcting the national deficiency of specialists in this field available as clinical consultants. In addition, similar needs exist in academia for clinically oriented faculty for the recommended expansion of clinical instruction in occupational and environmental medicine.
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From page 38... ...
The committee recommends that local, state, and federal health agencies develop and disseminate information on community disease and exposure patterns based on their surveillance and enforcement efforts. Previous outreach efforts in occupational and environmental diseases have produced either exhaustive lists of all etiologies or summaries of the average national experience (Centers for Disease Control, 1983; Rutstein etal., 1983~.
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From page 39... ...
State public health agencies, with the help of the CDC, could further expand their role in fostering occupational and environmental medicine in primary care practice by establishing associations or networks for primary care physicians who provide formal occupational and environmental health services. As general physician awareness and use of occupational and environmental medical consultations grow, the demand for physicians with skills in occupational and environmental medicine will increase.
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From page 40... ...
or local and state health departments would also assist primary care physicians in their continuing efforts to keep abreast of develop meets in occupational and environmental health. THE MACROENVIRONMENT OF MEDICAL PRACTICE System Interventions A variety of forces confront the physician who is involved in occupational and environmental medicine.
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From page 41... ...
, for cognitive services, and for preventive services. These and similar trends are likely to encourage primary care practitioners to prepare themselves arid keep abreast of occupational and environmental health concerns.
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From page 42... ...
This resource should include brief descriptions of the relevant agencies and laws, as well as the types of exposure and health effects data collected by and accessible through the agencies. These resources should be especially useful to primary care physicians engaged in occupational or environmental medicine.
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From page 43... ...
These spheres of influence can exert a strong and readily assimilated positive influence on physicians by recognizing and reinforcing their activities in occupational and environmental medicine. Primary care physicians belong to two types of professional organizations: those that include members from all specialties, which are generally geographically defined and have broad educational, social, economic, and political objectives and functions (for example, the American Medical Association and state and county medical societies)
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From page 44... ...
For example, they can invite and encourage primary care physicians to attend their local meetings, participate in educational programs at local hospitals and clinics, make rosters of specialty consultant resources available to primary care physicians, and prepare articles and case studies for publication injournals read by primary care physicians. Patient Demand Interventions Publicity about numerous health risk factors in the print and broadcast media has stimulated a sharp increase in public awareness of illness prevention measures.
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From page 45... ...
Federal agencies responsible for occupational and environmental health should give higher priority to proaci~vely developing accurate information about issues for dissemination to the media, with the goal of informing physicians indirectly through their patients. Information should be disseminated both in the form of tip sheets that outline issues and contact points for the press and through more in~epth features that are suitable for use by newspapers.
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From page 46... ...
Punters themselves {elf me that after they have applied themselves to their task the whole day long and have left the shop they, fancy even at night that those lefters which are pranted on their imagination keep moving to arad fro before their eyes for many hours, until their images are blotted out fly the forms of other objects.
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