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EDITORIAL |
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| Year : 2016 | Volume
: 20
| Issue : 3 | Page : 123-124 |
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Fitness and return to work challenges for occupational health physician
Ganesh K Kulkarni
Occupational Health Consultant, Chesnut Plaza, Shop No. 16, Second Floor, Opp. Endenwoods, B. Nath Pai Marg, Thane (W), Maharashtra, India
| Date of Web Publication | 28-Mar-2017 |
Correspondence Address:
Ganesh K Kulkarni
Occupational Health Consultant, Chesnut Plaza, Shop No. 16, Second Floor, Opp. Endenwoods, B. Nathpai Marg, Thane - 400 610, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijoem.IJOEM_39_17
How to cite this article:
Kulkarni GK. Fitness and return to work challenges for occupational health physician. Indian J Occup Environ Med 2016;20:123-4 |
In industry, people are employed based on their fitness, and are evaluated for fitness throughout their working life at least once in a calendar year. This fitness evaluation can be wellness-based or legally mandated exposure-based examinations; there are also some specialized areas such as food handlers, emergency medical response team members, and firefighting team members. The work related trauma, disease, or disorders have direct bearing on return to work fitness assessments.
The pre-placement fitness assessment is done to understand individuals physical and emotional capacity to perform a particular job, to assess individual's general health, and to establish a baseline record of the physical condition for epidemiologic and medicolegal purposes.[1] In USA and Europe, pre-employment examination is not necessary, however in India, one has to consider the nutritional status, high prevalence of infectious diseases such as tuberculosis and leprosy, congenital and rheumatic heart diseases, and lack of vaccine protection for preventable diseases. These make us feel that time is not ripe to get away from such fitness assessments now but things may change in future. Occupational health physicians must guard against unwanted rejections based on some conditions, which has no direct bearing on the person's capacity to perform the job.
After medical surveillance when one is looking at trending of some relevant biometrics may inadvertently correlate with occupational exposure without ruling out other confounding variables causing the same impact; this is one area where the occupation health physician can face the challenge. Another area of challenge is when the occupation health physician deals with musculoskeleteal disorder due to Ergonomic issues (ERGO) related issues at work place. In India, most of our population is physically inactive and prone to muscular strains, sprain, and nonspecific aches. In such a scenario, it is difficult to attribute it to work related. The approach should be evidence based in terms of cause–effect relationship, work station risk assessment, repetitive nature of work action, symptoms lasting more than a week at least in the last one year, and positive clinical signs and tests. If the physician does not follow the structured approach, then one ends up classifying most of the age-related degenerative conditions as work-related ERGO issues. The caution occupation health physician should follow is to conclusively establish the work place exposure to the offending agent and only scrutinize such a lot for occupational disease or condition. In such situations, the fitness and return to work can be challenging for the occupation health physician. When dealing with exposure to physical agents such as noise and vibration, occupation health physician needs to document baseline audiometry and vibration measurements properly. No baseline documentation can lead to legal issues and occupation health physician has no choice but to accept current status as due to present physical working environment, which can have complex influence in deciding modified work for such employees. Re-establishing zero audiometric baseline every year is an important function of occupation health physician and serves as good reference point for future assessments.
Following serious illness, many times employees want to return to work prematurely as it affects their economic situation. However, this can pose challenge to occupation health physician as he cannot recommend modified duty because of operational difficulty. Such situations should be approached with pragmatic and practical solutions without increasing the risk to employee's health. Occupation health physician and treating consultant may differ many times as there could be different perceptions with respect to fitness and return to work. One needs to trust upon collective decision by board of experts in that particular illness. Communication with treating consultant with relevant query helps in early return to work. As far as workplace injuries are concerned, employee motivation and work hardening process decides early return to work. Many times, practice of advising additional rest may not help the employee's recovery and should be cautiously advised by occupation health physician. The pregnancy risk assessment process should be in place to help women employees to decide to go on maternity leave, though they are defined by the law of the country. The organization must have a flexible policy to proceed on maternity leave and also return to work after delivery. Another gray area for policy makers is sports injuries whether internal sports activity or representing the organization in external sports tournaments, mostly it is driven by the company philosophy and may not add to loss of time work day.
The fitness and return to work should ensure safety to person and others at work and occupation health physician should not be biased to express his opinion that benefits organization and employees and takes care of issues critical to safety and health. Readers might have different views and are encouraged to express them through letters to editor, so that more learning can take place.
| References | |  |
| 1. | Zenz C. Occupational medicine, 3 rd ed. 1994. p. 13.  |
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