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Occupational medicine is in demise

BMJ 2015; 351 doi: (Published 11 November 2015) Cite this as: BMJ 2015;351:h5905

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Re: Occupational medicine is in demise

Raynal expresses the opinion that some European countries are managing occupational health better than the UK but I am curious to know on what evidence this is based? To answer this question reliably requires measurements of the true incidence of work-related diseases in different countries. European Occupational Diseases Statistics have not been collected since 2009 following a decision by the Health and Safety at Work Statistics Working Group on the grounds that the large variation in the data quality made it unreliable for cross-country comparisons. [1] Certainly some European countries fund occupational health services through private or state insurance premiums with the worthwhile goal of making employers pay for the costs of work-related diseases. In practice, however, this can result in a bureaucratic system that might penalise the worker. For example a worker may choose not to make claim during an economic recession or an insurer might decide to withdraw a benefit. Without some reliable data I am not convinced that one approach can be judged to be superior to another.

I agree with Nicholson’s point of view that concomitant changes in the types of work and exposures are a major factor in the “demise” of occupational medicine. To adapt to these changes, occupational physicians could work closely with GPs to take advantage of the increasing interest in occupational medicine among GPs described by Heron. For most patients in the UK the GP is the first point of contact in the healthcare system yet a patient’s occupation is rarely recorded in their health record. Why not record occupation routinely alongside other predictors of ill-health and exposures such as blood pressure, BMI, alcohol consumption and smoking status? The option to do so already exists in primary care electronic record systems. If recording occupation were to be incentivised in the same way as recording smoking status, the majority of patients could well have their occupation recorded in their electronic record within a few years. [2] This would increase awareness of occupational exposures and occupational medicine among GPs thereby benefiting patients with work-related diagnoses managed by their GP as well as increasing referrals to occupational physicians. Furthermore we would develop a better understanding of the relationship between health and occupation.

[1] Stocks SJ, McNamee R, van der Molen HF et al. Trends in incidence of occupational asthma, contact dermatitis, noise-induced hearing loss, carpal tunnel syndrome and upper limb musculoskeletal disorders in European countries from 2000 to 2012. Occup Environ Med. 2015;0:1–10. doi:10.1136/oemed-2014-102534
[2] Taggar JS, Coleman T, Lewis S, Szatkowski, L. The impact of the Quality and Outcomes Framework (QOF) on the recording of smoking targets in primary care medical records: cross-sectional analyses from The Health Improvement Network (THIN) database. BMC Public Health 2012, 12:329 doi:10.1186/1471-2458-12-329

Competing interests: The THOR project, which provided some of the data in reference 1, is partly funded by the UK HSE. Any opinions and conclusions expressed in reference 1 and this letter are solely those of the author(s). The author of the letter is not, and never has been, a grant holder on the THOR project and has not received any payments from the HSE. [Added on 22 December 2015 by Sharon Davies, The BMJ]

25 November 2015
Susan J Stocks
Core Research Fellow
NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester
Suite 10, 7th floor Williamson Building