Diagnosis of Occupational Diseases
Occupational disease is under-recognized.1 Failing to consider the workplace factors that may contribute to a patient's condition can result in the ordering of unnecessary tests, inappropriate referrals, and of equal or greater importance, a missed opportunity to protect others who may be at risk.1,2,3
Because time with the patient is limited, there are a few, simple questions that can assist in determining if a condition may be work-related.1 Providers should routinely ask their patients:
- "What kind of work do you do?"
- "Are you now or have you previously been exposed to dusts, fumes, chemicals, radiation, or loud noise?"
- "Are your symptoms better or worse when you are at work?"
- "Do you think your health problems are related to your work?"
If the replies to these questions rule out the likelihood of a condition being work-related, inquiries along this line can stop. If something is stated that arouses suspicion, a full occupational health history should be taken. Self-administered occupational history forms can be an efficient way to obtain this information and are available online at: www.atsdr.cdc.gov/HEC/CSEM/exphistory/exphist_form.html. It should be remembered that many occupational factors act in concert with non-occupational factors to cause disease, so indication of other etiologic factors, such as smoking, does not necessarily rule out a disease as also having an occupational etiologic component.2
If the initial evaluation raises the suspicion that the disease is related to the workplace, providers in New York State can utilize a statewide network of occupational health clinics for consultation and referral: www.health.state.ny.us/environmental/workplace/clinic_network.htm. Certain diseases, such as occupational lung diseases, pesticide poisonings, and heavy metals poisonings are reportable to the New York State Department of Health (NYSDOH). NYSDOH's authority in statute and regulation enables it to access and obtain this information in accordance with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The NYSDOH provides information to health care providers and their patients, and with a patient's permission, will work with employers to identify and correct hazardous workplace conditions. Patient's interests are always put first and their confidentiality is maintained.
1Newman LS. Occupational Illness. New England Journal of Medicine, 333:1126-1134, 1995.
2Rosenstock L, Cullen MR. Clinical Occupational Medicine. WB Saunders Company, Philadelphia PA, 1986.
3US DHHS, Agency for Toxic Substances and Disease Registry. Case Studies in Environmental Medicine. Taking an Exposure History. March 2000.
Physicians are required, by law, to report suspected cases of occupational lung disease to the New York State Department of Health. To file a report, call toll free: 1-866-807-2130
More information about lung diseases and physician reporting forms can be found at www.health.state.ny.us/environmental/workplace/lung_disease_registry/