A Portuguese-speaking male in his twenties with flu-like symptoms makes an appointment at a neighborhood health center to discuss upper respiratory symptoms and extreme fatigue. On arrival to his appointment, the nursing assistant (CNA) takes his weight, height, temperature and blood pressure, and asks him his current occupation and industry. The patient asks why the CNA needs to know his occupation. The CNA tells him that some jobs can affect a person’s health, and that information about occupation helps the health center take care of him. The patient tells her that he is a house painter for a local construction company. The CNA enters all the information into the center’s electronic health record (EHR). A nurse practitioner (NP) enters the exam room, greets the patient, notes the information on the intake entry screen, and asks him some questions about his symptoms. She informs him that that he likely has a viral upper respiratory infection.
The NP reviews the patient’s record to make sure he is up to date on other healthcare needs; she sees residential for-sale builders in the industry field and house painter in the occupational field. The health center providers have recently attended a training session about occupational lead poisoning. The medical director sent a follow-up email to remind the medical staff about blood lead testing, and to reiterate one of the points made in the training: that Portuguese-speaking workers have a higher risk of lead poisoning than other workers in the area. The NP confirms that he works as a painter and asks him if he has had a blood lead test since working as a painter. After he reports no previous lead testing, she orders a blood lead test. The test results show that the patient’s blood lead is elevated. The clinic staff refers the patient to an occupational health physician, who performs the appropriate evaluation and provides treatment and education to help the worker reduce exposure and prevent long-term complications of lead exposure.