Re: Occupational medicine is in demise: THE KlNG IS DEAD, LONG LlVE THE KlNG!
The personal view about occupational health in Great Britain and its dark future is interesting and disturbing.[1] With differences, many similar questions are being raised in many countries, like France, with discussions about cost-effectiveness, job fitness, and the role of occupational medicine.[2,3] However, this might well be an opportunity to metamorphose, by changing our occupational health systems.
Actually, the systems might be evolving towards a structure with primary, secondary, and tertiary levels of preventive medicine (similar to the health care system): with, at the first level, occupational nurses and technicians, for all workers; at the second level, occupational physicians and engineers for workers with health problems and specific exposures. Both these levels could be directly related to companies, and could send more complex questions and health problems to the tertiary level, with experts at the University hospital.[4] The primary and secondary levels would be in charge of on-site and field prevention, while the tertiary would deal with public health, training, and translational research. All these levels would work together in close interaction with the primary to tertiary care system.
With such an enhanced system, major steps could be taken to develop the prevention needed for emerging risks, while achieving health surveillance for all, and improving work ability and the return-to-work process, and also allowing special attention and surveillance for exceptional situations (such as for health professionals in the case of a tragic disaster such as that we have just experienced in Paris).[5]
References
1 Raynal A. Occupational medicine is in demise. BMJ 2015;351:h5905.
2 Frimat P, Fantoni-Quinton S. Occupational health: A new dynamic? Arch Mal Prof Environ 2014;75:469. doi:10.1016/j.admp.2014.07.003
3 Wurtz E, Fantoni Quinton S. The role of the occupational physician in the process of redeployment after declaration of unfitness. Arch Mal Prof Environ 2015;76:279–83. doi:10.1016/j.admp.2015.03.001
4 Descatha A. Translational units in occupational health: an innovative operational concept? Br J Hosp Med Lond Engl 2005 2013;74:706–7.
5 Descatha A, Dolveck F, Tate-Richier V, et al. The role of occupational physician in preparedness of a potential medical crisis. Arch Mal Prof Environ 2007;68:258–63.
Acknowledgements
I would like to thank Richard Carter for helping us to improve the language of this document.
Competing interests:
Alexis Descatha has received fees from the National health insurance for work compensation/penibilty for his expertise in the field (indemnity independent of any decisions he has made about accepting or refusing cases), from Elsevier Masson as editor-in-chief of the journal “Les archives des maladies professionnelles et de l’environnement”, in addition to his supportive institution (Versailles University and Paris Hospital).
15 November 2015
Alexis Descatha
Professor in occupational medicine, epidemiologist, emergency doctor
Paris Hospital (AP-HP), Versailles St-Quentin University (UVSQ), Inserm; Occupational Health Unit, EMS (Samu92), Inserm UMS 011 UMR-S 1168
University hospital of West Suburb of Paris, Poincaré site, F92380 Garches, France
Rapid Response:
Re: Occupational medicine is in demise: THE KlNG IS DEAD, LONG LlVE THE KlNG!
The personal view about occupational health in Great Britain and its dark future is interesting and disturbing.[1] With differences, many similar questions are being raised in many countries, like France, with discussions about cost-effectiveness, job fitness, and the role of occupational medicine.[2,3] However, this might well be an opportunity to metamorphose, by changing our occupational health systems.
Actually, the systems might be evolving towards a structure with primary, secondary, and tertiary levels of preventive medicine (similar to the health care system): with, at the first level, occupational nurses and technicians, for all workers; at the second level, occupational physicians and engineers for workers with health problems and specific exposures. Both these levels could be directly related to companies, and could send more complex questions and health problems to the tertiary level, with experts at the University hospital.[4] The primary and secondary levels would be in charge of on-site and field prevention, while the tertiary would deal with public health, training, and translational research. All these levels would work together in close interaction with the primary to tertiary care system.
With such an enhanced system, major steps could be taken to develop the prevention needed for emerging risks, while achieving health surveillance for all, and improving work ability and the return-to-work process, and also allowing special attention and surveillance for exceptional situations (such as for health professionals in the case of a tragic disaster such as that we have just experienced in Paris).[5]
References
1 Raynal A. Occupational medicine is in demise. BMJ 2015;351:h5905.
2 Frimat P, Fantoni-Quinton S. Occupational health: A new dynamic? Arch Mal Prof Environ 2014;75:469. doi:10.1016/j.admp.2014.07.003
3 Wurtz E, Fantoni Quinton S. The role of the occupational physician in the process of redeployment after declaration of unfitness. Arch Mal Prof Environ 2015;76:279–83. doi:10.1016/j.admp.2015.03.001
4 Descatha A. Translational units in occupational health: an innovative operational concept? Br J Hosp Med Lond Engl 2005 2013;74:706–7.
5 Descatha A, Dolveck F, Tate-Richier V, et al. The role of occupational physician in preparedness of a potential medical crisis. Arch Mal Prof Environ 2007;68:258–63.
Acknowledgements
I would like to thank Richard Carter for helping us to improve the language of this document.
Competing interests: Alexis Descatha has received fees from the National health insurance for work compensation/penibilty for his expertise in the field (indemnity independent of any decisions he has made about accepting or refusing cases), from Elsevier Masson as editor-in-chief of the journal “Les archives des maladies professionnelles et de l’environnement”, in addition to his supportive institution (Versailles University and Paris Hospital).