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. 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 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/
and
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.
o:925-820-7758
c:925-368-3367