Occupational medicine clinical practice and health assessment
Start with the job, not the diagnosis
Occupational medicine questions usually hinge on whether work caused, aggravated or merely coexists with a condition. The occupational history must capture current and previous job titles, the actual tasks performed (not the label), the materials handled with safety data sheets, the pattern of controls and PPE, and - critically - the temporal relationship between exposure and symptoms. Ask whether symptoms improve on days off, at weekends or on holiday; improvement away from work is the single most useful discriminator between occupational and non-occupational disease.
Distinguish occupational disease (caused by work), work-related disease (work is one of several contributors, e.g. most musculoskeletal complaints and common mental health problems) and work-aggravated disease (a pre-existing condition made worse). The distinction drives both clinical advice and legal entitlement.
Health surveillance is a statutory, risk-based programme of checks for identifiable conditions in identifiable groups (skin checks with sensitisers, spirometry for isocyanate workers, audiometry for noise-exposed staff). It is not a general 'medical'. Traps: confusing surveillance with screening or with fitness assessment; disclosing diagnoses to managers without consent; using a pre-placement assessment to exclude people with disabilities who could work with adjustments.
Worked example. A 44-year-old spray painter develops wheeze and rhinitis six months after starting two-pack isocyanate paint. The first step is not a chest X-ray but serial peak expiratory flow four times daily for at least three weeks, plotted against work and rest days, plus specific IgE to isocyanate-HSA. A flat trace across both work and rest periods argues against occupational asthma.
Rule of thumb: if the patient cannot tell you what is in the drum, the exposure history is incomplete.