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The occupational
history is a two-part process. The first step consists of asking a
few routine questions to screen for any relation between the
patient’s occupation and their symptoms. The second part consists of
a more detailed inquiry into the patient’s occupational background
if the answers to the initial questions aroused clinical suspicion
(Reference 1).
Medical
Component of the Occupational
History
What is the purpose of the
occupational history? To help
determine if the illness is due to or exacerbated by factors in the
work environment. Many
occupational exposures manifest with nonspecific symptoms and the
patient may be unaware of any connection. If an occupational etiology
for an illness is missed, exposures may continue and treatment will
fail. The problem may
go beyond the patient and co-workers could be affected also.
The Screening Occupational
History
When should a screening occupational
history be performed? (Reference 2)
- Every medical history should include
the patient’s current job and two major previous jobs
- Any respiratory symptoms may be
work-related
- The examiner should be suspicious if
the patient: has acute respiratory symptoms, has adult onset asthma,
has an illness of unknown cause, has suspected COPD which may be
asbestosis, is returning to work after leaving due to
illness
How is a screening occupational
history performed?
Several formats exist but the Medical
University of South Carolina developed one for use in primary
care. The mnemonic is
WHACS and the questions associated with it are: What
do you do?, How do you do it?, Are you concerned about
any of your exposures on and off the job?, Co-workers or
others exposed?, Satisfied with your job? (Source: Schuman et. al., 1997).
When do you go beyond a screening
occupational history?
The examiner should stop if all initial
inquiries in the screening occupational history are negative. If the
answers to the screening questions suggest that the person’s
occupation has a role in the development of their illness, more
detailed questioning is warranted.
How do you perform a more detailed
occupational history? (Reference
4)
Go to this link to see an example of an
occupational and environmental history form.
Below are written
descriptions of the steps involved in a more detailed occupational
history.
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Step
1: A description of all jobs
held by the patient. The employer, industry, job title and job description and the
length of time spent at that job should be recorded. Also, get the patient to
describe their typical shifts in a week. Several printed forms exist
and are easy for the patient to fill out and are able to be scanned
quickly by the physician.
The patient should include all second, summer and temporary
jobs held. The
workstation and any tools used should also be discussed to see if
they are related to the illness or if they are modifiable. Piece rate work and
productivity requirements are organizational factors at work that
may put pressure on the employees to not rest and therefore
contribute to the development of work-related illness.
Step 2: Categorize any exposures
that occur at the workplace. A
list of exposures can be provided and the patient can choose those
that apply. Further
information on chemical exposures can be found on Material Safety
Data Sheets (MSDS) or from computerized databases. As well, ask about any
unusual incidents or accidents that may have resulted in
exposures.
Step 3: Assess the timing of the
exposures. Some example questions
to ask to establish the timing are included below (Reference
2).
Do the symptoms begin at the start of
the workday?
Do the symptoms disappear after leaving
work?
Are the symptoms present at home, on
weekends, or on vacation?
Are the symptoms related to specific
work tasks or processes?
Have you begun a new job or is a new
chemical being used?
Step 4: Ask if co-workers are
affected.
Step 5: Non-work exposures.
This includes determining several
details about the home environment that may contribute to an
illness. The type of
residence and its ventilation, the presence of animals in the home,
any hobbies or living with someone who is exposed at their work
environment and brings substances home on their clothing or skin are
all examples of areas that can be evaluated as necessary. It is important to consider
both occupational and non-occupational factors in the etiology of
any disease, as they may co-exist.
References
1.
Newman L. Occupational Illness. The New England Journal of Medicine
333(17):1129-1134.
2. Liss G. 1998. Important Aspects of
the Occupational History. Physician Education Project in Workplace
Health.
3. Schuman S., Mohr L., Simpson W. 1997.
A Clinical Guide to the Occupational and Environmental Patient in a
Busy Family Practice: the Two-task, Four-prototype Approach in the
SC/EHAP Initiative. Journal of Occupational and Environmental
Medicine 39:1191-1194.
4.Wegman D., Levy B., Halperin W. 1995.
Recognizing and Preventing Occupational Disease. Chapter 3. In: Levy
B., Wegman D., eds. Recognizing and Preventing Work-Related Disease.
3rd ed. Toronto: Little, Brown and Company, pages 57-82. |
