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Views & Reviews Personal View

Occupational medicine is in demise

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5905 (Published 11 November 2015) Cite this as: BMJ 2015;351:h5905

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Re: Occupational medicine is in demise

Some interesting points have been made in response to Anne Raynal’s Personal View on the demise of occupational medicine. I was an academic and therefore on the periphery of service occupational medicine but, as a researcher and educator, was in contact with many occupational physicians, in a variety of industries, for 35 years. No-one yet has commented on a key point in the article: the lack of statutory protection for occupational physicians in the UK. There is also another point implied in Dr Raynal’s article but not made explicit: the lack, in the UK, of specialist referral services for occupational medicine.

If the UK government wished to be effective in making occupational disease a priority, one thing it could do would be to ensure statutory protection. Contrary to the assertions made in some responses, intimidation of occupational physicians is not uncommon. Most doctors outside occupational medicine are not aware that it is the employer, rather than the doctor, who reports a reportable occupational disease. I know of instances of occupational physicians being ‘leaned on’ not to write, or to rephrase, internal memoranda because if the employer does not ‘know’ about a case of an occupational disease, there is no need to make a report. This intimidation extends to other areas and I am also aware of occupational physicians being instructed by their employer to remove from their letters of advice any mention of the possible alterations the employer could make to the workplace or to work practices.

Secondly, the UK is one of the few developed countries that does not have a niche within its healthcare system for specialist referrals in occupational medicine. There is no recognised referral pathway for a GP who suspects that a condition might be work-related, or who wants specialist advice on another occupational topic. There are some hospital consultants in the NHS who have a sub-specialty interest in occupational diseases, e.g. within dermatology or respiratory medicine. But these are tertiary referral services, largely taking referrals initiated by other consultants (although the GP may make the actual referral to satisfy current referral rules). The services are often ad hoc, having arisen because of the interests of one particular consultant. If occupational diseases are to be taken seriously in the UK, there should be outpatient clinics and investigatory services to which GPs can refer. As Dr Raynal implies, to some extent the Employment Medical Advisory Service fulfilled this role in its early days.

Some responses have focussed on the multi-disciplinary nature of occupational health services. But I did not see Dr Raynal’s argument as in any sense opposed to multidisciplinary services. It is the same as in, say, surgery. An effective surgical service depends on a great many individuals from a variety of disciplines. The specialist surgeon is in a minority in the team. But that fact does not detract from the necessity of fostering the education and supporting the professional independence of the specialist surgeon.

Competing interests: No competing interests

09 December 2015
Katherine M Venables
Emeritus Reader
Oxford