Consider a specific adult patient you have seen in general medical practice
or in hospital, and who is suffering from a disease such as asthma, dermatitis,
or back pain. Take a careful occupational
history as well as a history of other relevant exposures: DIY, leisure
Is it possible that some of these exposures could be contributing
to the ill-health, by causing it, or by aggravating it?
If this is a possibility, consider the answers to the following questions:
To what hazards is the patient
exposed? (You may wish to consult some guidance regarding the influence
of Work on Health)
How can you determine the extent of exposure
to the hazards?
Therefore what is the patient's 'a priori' risk of work-related
How may the patient's symptoms and signs relate to the occupational
risks in terms of ...timing? ...severity? ...biological plausibility? ...consistency
with other observations? (Remember the epidemiologic criteria for causal
association, and consider the clinical analogies)
What steps would you consider to protect the patient, by reducing exposure
... at source? or... through personal protection? or in other ways?
Who would you liase with, to achieve these aims?
What about the risks to other workers: How would one determine the frequency
of similar ill-health amongst fellow workers? ... How would one find out
who was at risk?... What steps should be taken to protect them?