1~~ ~ ~~~~~~~~~~~~~~~~~~~~ A Bird's Eye View of Occupational

Medicine Eloise De Lain, MD, MPH Zion, Illinois

This article defines occupational medicine, outlines the training involved, and describes various phases of occupational medicine. It is based on the author's experience and training.

Duties

the workplace, job, and worker so that there may be a mutually beneficial blending of the three. He is not only concerned with the physical status of the patient but also with the physical status of the plant such as lighting, ventilation, positioning of the worker in various jobs, type of tools used (whether or not the tools indirectly create new health problems for the worker). Is the worker using innocuous or hazardous substances? If the latter is true, then what methods are being employed or precautions taken to diminish the exposure of the worker to such substances? Are the toxicities of substances being used thoroughly understood and what research is being done to evaluate the problems? The occupational medical specialist consults with design engineers, production engineers, foremen, management and union representatives (if there are such), and various employee representatives in order to spot health hazards early. He and his nurses go on inspection tours, alone or with the safety officials, to see the worksite, talk with employees, and observe compliance of good work practices. He is receptive to observances by and complaints from employees, union, and management regarding safety, health, or environmental hazards and endeavors to have these problems identified and solved by referring them to the appropriate specialty. Where hazardous materials are unavoidable, the OM specialist attempts to assure use of proper industrial hygiene and safety principles as well as use of indicated personal protective devices to minimize dangers. Just as the industrial

The physician specializing in occupational medicine is trained to evaluate

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Clientele

The picture that most frequently comes to mind when hearing the term occupational or industrial medicine is that of a surgeon suturing the semiamputated employee-victim of an industrial accident. An occupational medicine (OM) specialist does handle trauma but also does much more. Indeed, when the OM specialist is practicing his specialty to the fullest, he is able to reduce the number of traumatic or accident cases to a small fraction of his typical daily problems.

All occupational medicine patients are employed persons and the general milieu is that of the workplace. His primary goal is a healthy worker in a safe work environment. To be most effective, the occupational medicine specialist can be neither strictly promanagement, pro-employee, nor prounion. He or she is first and foremost pro good preventive medicine and safe work practices.

Training

Objectives

Occupational medicine is a subspecialty of the American Board of Pre-

He strives to maintain utmost confidentiality in all his relationships with both employees and management, be it on an official or nonofficial level. He never supplants nor competes with the employees' own private physician. Rather, he is an extension of and consultant to the private physician and community. The occupational medicine specialist thoroughly knows the work milieu of patients and therefore can better correlate certain -signs and symptoms: recognizing diseases prevalent in industry more quickly than the community physician, who is thoroughly engrossed in the more common illnesses. As such, the occupational medical specialist may alert a private physician to the fact that the patient's acne or asthma is not the mundane type but, respectively, a chloracne or baker's asthma.

ventive Medicine and Public Health. In addition to the usual physician's training, a specialist in occupational medicine takes a clinical residency both in the hospital and in industry. He gets academic training in a school of public health in the fields of industrial toxicology, industrial hygiene, general public health, clinical occupational medicine, administration of occupational health programs, ecology, air pollution, ergonomics, environmental health, biostatistics, radiation health, epidemiology, safety, labor relations, disability evaluations, occupational mental health, workmen's compensation, computer science, medical jurisprudence, and all occupational diseases known to date. He may further subspecialize in aerospace or underwater medicine. Requests for reprints should be addressed to Dr. Eloise De Lain, 2441 Sheridan Road, Zion, IL 60099.

JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 12, 1979

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hygienist monitors the environment through periodic physical examinations, the OM specialist monitors workers in order to find those who are succumbing to certain illnesses and provide proper treatment before others become critically ill. Being interested in the general well-being of all employed persons, he conducts pre-employment physical examinations in an endeavor to see that each person is physically and mentally fit for the assigned position and that no one is placed in ajob in which he would be incapable of performing to the best of his ability or would be harmful to himself or fellow employees.

Long Range Goals As a specialist in public health and with the aid of the nursing staff, the OM physician attempts to obtain better compliance of safety and health regulations via continuous health education programs of management and labor. He works with industrial relations and personnel departments in obtaining contracts flexible enough so that handicapped or temporarily disabled workers also may find work within their current capabilities, even if it means crossing traditional worklines or infractions of seniority rights. He works with the benefits department in pointing out employees in need of certain health benefits or compensation. Thus, he works towards fulfilling the United Nations objective of, "A job for all those wanting and able to work." Through programs on health main-

tenance, health risk identification and prevention, pre-retirement physicals and counseling, the OM physician assists private physicians in discovering early signs of potentially serious illnesses. Results are sent to private physicians, at the patient's request, for follow-up and appropriate specialist referral. Thus, the employee may be spared suffering a long, painful, and costly illness and the employer, huge medical bills and the employment of an extra employee while the other recuperates. The occupational medical specialist is an observer, examiner, and adviser to industry. He reviews accident and compensation cases and is always on the alert for patterns and trends pointing to new or old problems. He tries to eliminate or diminish the number of industrial accidents or illnesses. He reviews absentee and sickness records looking for causal relationships. Where indicated, he sets up troubled employee programs for valued employees to help them discover causes and solutions to their problems so that they may again become productive to themselves, the employer, and the community. The end result of a smoothly running, well-managed occupational medicine program where everyone cooperates is a reduction in overall costs of production, repairs, insurance, absenteeism, and employee turnover. Such programs are cost effective and in the long-run save thousands of dollars for industry and years of pain and suffering for afflicted workers. Everyone profits in a healthy environment.

Diversification Within the Field of Occupational Medicine There are many types of occupational medical specialists, just as there are of surgeons. This is to fit the various needs of different industries, from aerospace to coal mines and from restaurants to zoological gardens. Some work as independent consultants, some have clinics specializing in trauma and pre-employment examinations. Others deal exclusively in health risk identification, and some work with mobile health units providing a full range of industrial hygiene as well as medical and laboratory services. Some work for the government or in research to find better ways of detecting and treating occupationally induced diseases. Large plants and factories have in-house medical departments and some unions have their own clinics and consultants. Professors of occupational medicine are performing a vital role by passing on their knowledge and experience to others so that they may avoid the mistakes of the past, profit from discoveries of the present, and work for a better future. Regardless of the branch of occupational medicine, the aim is basically the same: to detect the detectable; prevent the preventable; eradicate the eradicable; treat the treatable; rehabilitate the rehabilitable: and ensure a healthy environment in which all men may continue to work and grow.

Apartheid: Focus on Health George B. Dines Washington, DC

This paper focuses on health in the Republic of South Africa and calls not only for technical warfare against disease, poverty, and bigotry but also for attention to predisposing causes of disease and ill health among the African majority. Apartheid-the legally enforced racial segregation of blacks from whitespermeates the total structure of South Africa's existence. The Republic of Mr. Dines is Assistant Director for Program Management, Office of International Health, Department of Health, Education, and Welfare. Requests for reprints should be addressed to George B. Dines, 810 Downs Drive, Silver Spring, MD 20904.

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South Africa is a country where the white Afrikaners number only four million of the blacks' 18 million, where there are 2'/2 million coloreds and 800,000 Indians, a country where there is every reason for the growing fears of the white Afrikaners that the threat of violence is eminent.' In the apartheid social drama, sickness and disease

have a strong claim among the Africans (Bantu); it is one of their arch villains. It is bad enough that any man, black or white, should be unhealthy, for this cuts him off from the fullest accomplishment of his abilities. It is, perhaps, worse that any man should be poor in a nation so rich, for this condemns him to a life of pain, despair, and helplessness. But in South Africa, what surely is worse is that the system dictates that a man who happens to be born African should be unwell, since this position Briefs continued on page 1233

JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 12, 1979

A bird's eye view of occupational medicine.

1~~ ~ ~~~~~~~~~~~~~~~~~~~~ A Bird's Eye View of Occupational Medicine Eloise De Lain, MD, MPH Zion, Illinois This article defines occupational medic...
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