[MCOH-EH] info re: Fit for Duty related to WC costs

[Dr Joe Fanucchi]

Colleagues,

There have been a number of studies on this subject. The first of which 
I'm aware was done back in the mid-eighties by Dr Gil Lowenthal at the 
Cleveland Clinic. Gil was a founding member of what is now the ACOEM 
Medical Center Occupational Health Section, and a dedicated "thinker 
outside the box" back when nearly everyone was doing comprehensive 
pre-employment physical exams. At the time, many of us in the 
medical-center community stopped doing workforce-wide evaluations based 
on that study, which found no advantage in performing a physical 
evaluation as compared to requiring a questionnaire.

I'll post just two relatively recent references here:
------------------------------------------------------------------------
The World Health Organization in 2008 published a study entitled 
*Evidence base for pre-employment medical screening* 
<http://www.who.int/bulletin/volumes/87/7/08-052605/en/>. Among its 
conclusions:

/Any health assessment should be appropriate to the requirement.39 
Medical examinations are only justified when the job involves working in 
hazardous environments, requires high standards of fitness, is required 
by law or when the safety of other workers or of the public is 
concerned. Generally, a health assessment by questionnaire should 
suffice and physicians should advise against the application of physical 
or mental standards that are not relevant to fulfilment of the essential 
job functions...//
//Three specific recommendations are suggested. First, to eliminate the 
pre-employment physical examination. It is reasonable to require an 
applicant to complete a medical history form.Three specific 
recommendations are suggested...//
//Second, to eliminate pre-employment drug screening. There is 
insufficient evidence to suggest that this process is cost-effective. 
This screening likely represents an expensive and redundant alternative 
to an examination of previous work history.//..//
//Third, to develop some consensus regarding best practice and conduct 
clinical trials regarding assumptions. If a set of consensus-based 
recommendations can be developed, assistance should be provided to 
medical directors and others to implement change./
------------------------------------------------------------------------
More recently, The Cochrane Collaboration in 2011 published a review 
entitled *Pre-employment examinations for preventing occupational injury 
and disease in workers* 
<http://www.udea.edu.co/portal/page/portal/bibliotecaSedesDependencias/unidadesAcademicas/FacultadNacionalSaludPublica/Diseno/archivos/General/Pre-employment%20examinations%20for%20preventing%20occupational.pdf> 
which concluded*
*/
//There is very low quality evidence that pre-employment examinations 
that are specific to certain jobs or health problems could reduce 
occupational disease, injury, or sickness absence. This supports the 
current policy to restrict pre-employment examinations to job-specific 
examinations. More studies are needed that take into account the harms 
of rejecting job applicants./

These articles are available at
www.who.int/bulletin/volumes/87/7/08-052605/en/ 
<http://www.who.int/bulletin/volumes/87/7/08-052605/en/>
and
www.udea.edu.co/portal/page/portal/bibliotecaSedesDependencias/unidadesAcademicas/FacultadNacionalSaludPublica/Diseno/archivos/General/Pre-employment%20examinations%20for%20preventing%20occupational.pdf 
<http://www.udea.edu.co/portal/page/portal/bibliotecaSedesDependencias/unidadesAcademicas/FacultadNacionalSaludPublica/Diseno/archivos/General/Pre-employment%20examinations%20for%20preventing%20occupational.pdf>

Hope this helps,

-- 
*Joe Fanucchi MD FACOEM*
President and Medical Director
MediTrax / OHS, Inc. <http://www.meditrax.com/>
o:925-820-7758
c:925-368-3367
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