Occupational Health

A Beginner’s guide

Occupational Medicine

• A speciality concerned with the recognition, prevention and control of work on health and the effective management of the employment problem caused by ill health

In Short:

• Effect of Work on Health: Occupational Disease etc

• Effect of (Ill) Health on Work: Fitness to Work

Occupational Health and you

• As an employee: Hep B status, pre-employment health screening

• Asked to provide GP report by OH professional

• Med 3: by issuing or refusing a sick note you are giving medical opinion on your patients fitness to work

Occupational Health and your Patients

• To understand your patients and their problems properly you should know what they do for a living.

• Don’t settle for a job title – ask them what they actually do!

A few interesting bits out of the journals…

Downsizing doubles death rate

• Drastic downsizing (18% or more) doubles death rate of cardio-vascular disease in remaining workforce

Quality of life and ill health retirement

• The quality of life of people retiring for ill health from the NHS improved one year after retirement but was lower than that of the general population.

• Those who found redeployment had higher quality of life.

• ?cause - ?effect

Do Junior Doctors take Sick Leave

• Audit of junior doctor sick leave in large teaching hospital 1993 and 2001

• Similar number reported infectious illness episode during previous 6/12 (61.2% in 1993; 68,2% in 2001)

• Higher percentage of the the episodes for which sick leave was taken in 2001: 36.8% as opposed to 15.1% in 1993

Psychometric Profile and Back Pain

• Patients who had undergone MRI scan, CT scan or discography were psychometrically profiled and followed up.

• Psychometric profile at the start of the study strongly and independently predicted future back pain, medication usage and absence from work.

• Annular disruption on MRI was weakly predictive.

• Discography was not predictive

CBI Absence and Labour Turnover report 2002

• 166 million working day lost due to sickness absence, 6.8 days per worker, 2.9% of total working time

• Public sector 8.9 days

• Private sector 6.5 days

• Larger companies (>5000) 9.3 days

• Smaller companies (<50) 4.9 days

Disability (Discrimination) Act 1995

• It is unlawful for employers to discriminate against current or prospective employees with a disability because of a reason related to their disability.

• Employers have to make reasonable adjustments if employment arrangements or premises substantially disadvantage a disabled person in recruitment or retention

Disability according to the DDA

• Physical or mental impairment, which has a substantial and long term adverse effect on a person’s ability to carry out normal day to day activities.

• Long term: has lasted or likely to last longer than 12 months or recurrent beyond 12 months or progressive

• Day to day activities: Mobility (cross a road safely), manual dexterity, physical coordination, continence, lift, carry or otherwise move every day objects, speech, hearing, eyesight, memory, concentrate, learn and understand

Management (of Health and Safety at Work) Regulations

1992• Every employer must make a suitable and

sufficient assessment of risks to the health and safety of his employees and third parties arising from the conduct of his undertaking, take suitable preventative and protective measures, employ competent persons to assist him, provide health surveillance for his employees as is appropriate.

Role of Occupational Physician

• Occupational physicians like other doctors have an ethical responsibility to put the interest of the individual patient first.

• But he is employed as an advisor to the management.

• Potential conflict of interests.

Some cases

Kitchen Assistant

• 36 years old male

• 10 episodes of sick leave (total 46 days) in last 2 years

• Multiple diagnoses: cold, stomach upset, back pain, ankle sprain, headache

• Off sick over last 3 Christmas holidays

Office Worker

• 35 year old male

• Multiple short term sickness absences, mainly colds, sore throat, stomach upset, sinusitis

• 21 days in last two years, appears to use all his annual leave to cover for sickness

Kitchen Assistant

• 42 year old female

• Very good sickness record, but on continuous sick leave for last 3 months with back pain

Factory Worker

40 year old male hardly ever been ill before.

Narrowly escaped an accident, which almost certainly would have been fatal.

2 year later still on antidepressants, been assessed for chronic headaches without diagnosis

Meat Factory Worker

• 50 year old male

• Narrowly escaped a potentially fatal accident with liquid nitrogen

Shop Floor Manager in Food Processing Plant

• 42 year old male• Had “nervous break down” at 3am after having tried to

fix a technical problem for which he was called in at 11pm.

• Works normal 9 to 5 hours plus on call 24/7 – and regularly does get called out.

• Has worked most of his working life with the company, feels very loyal.

• Still off sick nearly 12 month after incident, suffering from severe anxiety, social phobia, insomnia loss of libido and anhedonia.