Recognition and evaluation of occupational and environmental health problems.
Environmental and occupational medicine, third edition. Rom WN, ed. Philadelphia, PA: Lippencott-Raven Publishers, 1998 Sep; :11-18
Most occupational and environmental diseases present as common medical problems or have nonspecific symptoms. Indeed, it is the etiology, rather than the pathology, that generally distinguishes disorders as occupational or environmental illnesses. It has been estimated that the workplace attribution for over 60% of occupational diseases may be unrecognized (1). Thus, clinicians must maintain a high index of suspicion for disorders that may indeed have an occupational or environmental cause. A brief occupational and environmental history should be part of every medical history. In recognition of this need, the Healthy People 2000 goals for Occupational Safety and Health (2) include the following: "Increase to at 75% the proportion of primary care providers who routinely elicit occupational health exposures as part of their patient history and provide relevant counsel." The occupational medicine literature contains numerous references to the so-called astute clinicians who first made the connections between occupational exposures and specific disease entities (3). These range from the historical descriptions of scrotal cancer in chimney sweeps to more recent descriptions of angiosarcomas of the liver form vinyl chloride and male infertility associated with dibromochloropropane.
Physical-examination; Physical-fitness; Occupational-hazards; Occupational-exposure; Medical-examinations; Medical-care
National Institute for Occupational Safety and Health, Division of Respiratory Disease Studies, Morgantown, WV 26505
Environmental and occupational medicine, third edition