Taking an occupational history

1
Taking an occupational history
Grant McMillan Hon Senior Clinical Lecturer
Institute of Occupational and Environmental
Health University of Birmingham Number 4 of a
series of lectures and tutorials for medical
undergraduates
2
This is a self-help tutorial designed to provide
you with an introduction to taking an
occupational history
Learning Points

• What is an occupational history?
• Why take an occupational history?
• Deciding between a full or only current
  occupational history.
• General procedure standard form.
• Key questions.

3
What is an occupational history?
An occupational history is a chronological list
of all the patients employment, with dates,
expanded as necessary to detail any evidence of
occupational exposure to potentially hazardous
agents and resulting effects on health.
4
Note the key words in the definition
An occupational history is a chronological list
of all the patients employment, with dates, from
leaving school or even earlier. It may be
expanded as necessary to detail any evidence of
occupational exposure to potentially hazardous
agents and resulting effects on health.
5
Why take an occupational history?

• To determine if there is evidence that
• Work is a cause of ill health
• Work has aggravated existing ill health.
• Health or ill health has an effect on the
  capacity for work.

6
An occupational history is the most effective
instrument for the proper diagnosis of
occupational disease if it provides evidence
which generates informed suspicion of risk of
harm which is acted upon correctly. Now, look
at the three parts of this statement
7
An occupational history is the most effective
instrument for the proper diagnosis of
occupational disease
8
if it provides evidence which generates informed
suspicion of risk of harm.. which is acted
upon correctly.
9
An occupational history may also be an effective
instrument for assisting return to work after
injury or disease
10
An occupational history may also be an effective
instrument for assisting return to work after
injury or disease if it helps to identify
required standards in health or fitness and how
the individual measures up to these.
11
The occupational history or exposure history
seeks to define possible exposure to hazards to
health and links with actual ill-health outcomes.
12
Current job only or full occupational history?

• Work-related illnesses often present with common
  signs and symptoms.
• Where you suspect an occupational aetiology,
  start with the current job.
• In acute cases, only the current job and
  exposures in last 24 hours are likely to be
  relevant.

13
Moving to a fuller occupational history

• Move to a fuller history if the short history
• does not provide a solution
• suggests that the problem may have started in a
  previous job or
• if the adverse health outcome is one of a list of
  specific disorders which merit deeper probing.

14
Specific disorders when you should probe more
deeply

• anaemia
• asthma, acute bronchitis, pneumonitis
• chronic lung disease
• dermatitis
• headaches
• hepatitis
• injury
• nausea and vomiting of unknown origin
• new onset of depression/irritability
• neuropathy
• pneumoconiosis
• renal failure
• reproductive anomalies

15
Procedures for taking an occupational history

• Oral questioning about current job. Patient
  probably has good recall. Usually a quick
  process.
• Oral questioning about previous jobs. Expect gaps
  initially and limited or poor recall on dates.
  This can be a slow process which takes much
  doctor time
• There is advantage in leaving the patient with a
  pro forma about previous jobs to complete in
  his/her own time then returning to question.
  Experience shows that this reduces gaps and
  inaccuracy which would be present without such an
  aid. It also reduces the time the doctor must be
  present.

16
Procedures for taking an occupational history

• A good pro forma completed in the patients in
  own time oral questioning probably gives best
  chance of full and accurate account and is
  economic with doctors time.

17
Key questions - 1

• What work do you do? or Do you have a job?
• or What is your job? or What do you do for a
  living? (Record name and address of employer)
• Is it full time or part time?
• How long have you been doing this job?
• In what year and month did you start?
• How long is your working day?
• Do you do shifts and what is the shift rotation?
• What is typical working day for you?

18
Key questions - 2

• What tasks do you do?
• What processes do you work with?
• How often?
• For how long each day?
• What materials do you work with?
• Do you have or have you had occupational exposure
  to fumes, chemicals, dust, loud noises,
  vibration, radiation or other occupational
  hazards?
• Take care with maintenance men and their
  exposures.

19
Key questions - 3

• Have you been told that any of these might make
  you ill, that is, are hazardous?
• Do you have a label, hazard sheet or COSHH
  assessment?
• How might you be exposed to this hazard?
• What is the extent of your exposure to these
  materials?

20
Key questions 4

• How is exposure controlled?
• Is there local extract ventilation?
• Do you wear special protective clothing?

21
Key questions - 5

• Do you have any special medical tests because of
  this work?
• Are you better at the weekend or on holidays?
• Does anyone at work have the same symptoms or
  other health problems?
• Have you done this job elsewhere in the past?

22
Key questions - 6

• Do you have a second (or third) job?
• If so, repeat questioning.

23
Key questions - 7

• What are your hobbies and past times?
• What DIY or housework do you do? (Examples to
  look for include adhesives and birds)
• Do any of these hobbies or activitiesbring you
  into contact with chemicals, impure chemicals,
  breakdown products?

24
Key questions - 8

• Are there any sources of environmental pollution
  in your area? For example, factories, waste sites
  or contaminated sources of water.

25
Key questions - 9

• Have you done any other kind of work?
• What jobs have you had since you left school?
• ie Move on to a full occupational history.

26
Key questions 10

• Check for gaps all to be explained. (Prison?)
• Have you served in the Armed Forces?
• Have you worked overseas?
• Has anyone who worked with you in the past had
  the same symptoms or other health problems?

27
Further reading

• Burge PS. How to take an occupational history
  relevant to lung disease. In Occupational
  Disorders of the Lung. Eds Hendrick DJ et al.
  Published by WB Saunders 2002
• Lee WR, Tar-Ching Aw. The occupational history.
  In Hunters Diseases of Occupations 9th edn. Eds
  Baxter PJ et al Eds. Arnold, London, 2000.