Many important problems are associated with the diagnosis and treatment of occupational and environmentally caused diseases, including (1) the ability to establish correctly the diagnosis, (2) the ability to treat the condition correctly, and (3) the ability to act correctly 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.
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 a physician with potential xenobiotic exposures at work or unusual symptoms. 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 122–1)?
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?
Table 122–1. Hazard Classes, Hazard Types, and Several Common Examples Found in the Workplace |Favorite Table|Download (.pdf)
Table 122–1. Hazard Classes, Hazard Types, and Several Common Examples Found in the Workplace
|Hazard Class||Hazard Type||Examples|
|Physical hazards||Human-machine interfaces||Repetitive motion |
|Mechanical trauma, electric shock|
|Long or rotating shifts|
|Energy||Ionizing radiation: x-ray, ultraviolet|
|Nonionizing radiation: infrared, microwave, magnetic fields|
|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)|
|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|
|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|
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 of the job, hazardous exposures, health effects, and control measures (...