Many important problems are associated with the diagnosis and treatment of occupational and environmentally caused diseases, including (1) the ability to correctly establish the diagnosis, (2) the ability to correctly treat the condition, and (3) the ability to correctly act on any public health issues related to the exposure. The following discussion instructs clinicians on how to assemble adequate information to achieve the appropriate diagnosis and treatment.
TAKING AN OCCUPATIONAL HISTORY
Because time spent at work is a large percentage of many people’s day, the occupational health history should be a routine part of any medical history. This is especially true of patients who present to health care with potential xenobiotic exposures. The history should include several brief survey questions. Positive responses then lead to a more detailed occupational and environmental history, which is composed of three elements: present work, past work, and nonoccupational exposures.
The Brief Occupational Survey
The following three questions should be incorporated into the occupational survey:
Exactly what kind of work do you do?
Are you exposed to any physical (radiation, noise, extremes of temperature or pressure), chemical (liquids, fumes, vapors, dusts, or mists), or biologic hazards at work (Table 123–1)?
TABLE 123–1.Hazard Classes, Hazard Types, and Several Common Examples Found in the Workplace |Favorite Table|Download (.pdf) TABLE 123–1. Hazard Classes, Hazard Types, and Several Common Examples Found in the Workplace
|Hazard Class ||Hazard Type ||Examples |
|Physical hazards ||Human–machine interfaces ||Repetitive motion |
| || ||Lifting |
| || ||Vibration |
| || ||Mechanical trauma, electric shock |
| ||Physical environment ||Temperature |
| || ||Pressure |
| || ||Long or rotating shifts |
| ||Energy ||Ionizing radiation: x-ray, ultraviolet |
| || ||Nonionizing radiation: infrared, microwave, magnetic fields |
| || ||Lasers |
| || ||Noise |
|Chemical hazards ||Solvents ||Aliphatics, aromatics, alcohols, ketones, ethers, aldehydes, acetates, peroxides, halogenated compounds |
| ||Metals ||Lead, mercury, cadmium |
| ||Gases ||Combustion products, irritants, simple and chemical asphyxiants, oxygen-deficient environments |
| ||Dusts ||Organic (wood) and inorganic (asbestos or silica), nano-materials |
| ||Pesticides ||Organic chlorine, organic phosphorus, carbamate |
| ||Epoxy resins and polymer systems ||Toluene diisocyanate, phthalates |
|Biologic hazards ||Bacteria ||Bacillus anthracis, Legionella pneumophila, Borrelia burgdorferi |
| ||Viruses ||Hepatitis, HIV, Hantavirus |
| ||Mycobacteria ||Mycobacterium tuberculosis |
| ||Rickettsia and Chlamydia ||Chlamydia psittaci, Coxiella burnetii |
| ||Fungi ||Histoplasma capsulatum, Coccidioides immitis |
| ||Parasites ||Echinococcus spp, Plasmodium spp |
| ||Envenomations ||Arthropod, marine, snake |
| ||Allergens ||Enzymes, animals, dusts, insects, latex, plant pollen dusts |
Are your symptoms related in any way to starting or being away from work? For example, do the symptoms start when you arrive at work at the beginning of the day or week or when you work at a specific location or during a specific process at work?
Collected data on a person’s present job reveal what his or her present exposures may be, which can help formulate the differential diagnosis for the employee’s complaints. These data can be systematically collected by focusing on four areas: specifics ...