Block 4 Week 4 - Occupational Health Flashcards
Work is….
What review paper backs this up?
Work is generally:
- Generally good for health
- Needs to be good work
- and is a Social Determinant of health: Marmot R/v: the lower social/ economic status -> the poorer the health and shorter life expectancy
What does worklessness lead to?
- •Poorer physical health –> more likely to die sooner
- •Poorer mental health
- •More medical care
- •Less social integration & loss self-confidence
- •Less monetary resources
- •Effect on next generation -> those born to unemployed parents have higher risk ill health
What does: Improving Lives. The Future of Work: Health & Disability White Paper 2017 state?
What does it say we should do in response to this?
- Disability employment gap: Need to provide support for disabled people in and out of work
- 1 in 3 of working age have L TC putting working participation at risk- give timely & appropriate health & employment support
What is the future of the workforce?
- 2020 1/ 3 workforce >50 yrs old
- Life Expectancy & Retirement age increasing but not disability free years are not!
- still going to become disabled at roughly the same age
Occupational Health- define
- Promotion & maintenance of the highest degree of: Physical, Mental & Social well-being of workers in all occupations
- Prevent ill health caused by working conditions
- place and maintain worker in occupational environment that is adapted to physiological and psychological capability -> adapt work to each person
What are the factors encouraging the sick role?
1/ Culture, Beliefs & Attitudes: (needs changing)
- Misconceptions about health & work (have to be 100% fit to work)
- Poor retention in work of those with disabilities/ chronic disease
2/ Inadequate Systems:
•No rapid intervention pathways keeping you in work or returning you to work
3/ Lack of Primary Care Involvement:
- Rehabilitation to work is not health care performance measure- it should be
- Lack OH advice
Give some examples of the changing nature of work
- Manufacturing –> Service industry
- Physical –> Sedentary
- Full time –> Flexitime/ Part Time
- Male –> Diverse
- Women at home –> Women at work
- Retire –> Work beyond 65
Give examples of work related ill health
a) During industrial revolution
b) Currently
Industrial Revolution
•Accidents, Poisoning, MSK
Current:
- MH- Depression/Anxiety
- MSK- Skin, Resp, Infection
Define a hazard?
What are the types of hazard?
Something that has the potential to cause harm
- Physical
- Chemical
- Mechanical
- Biological
- Organisational/ Psycho-social (Shift, Bullying, Workload, Commuting, Home-Work interface, Stress)
What is risk
The likelihood of harm actually occuring
What do risk assessments do?
Identify hazard
Ax risk to health
Manage/ Control risks
Mental health- what are the stats?
1 in 5 have MH condition
What are the causes of MH @ work?
1/ Demands
- workload vs percieved capacity
- Family/ personal life
2/ Control -> pace or organisation of work
3/ Support -> colleagues/ manager/ human resources etc
How can a Dr recognise work related ill health?
- History
- Examination
- Investigation
What questions would you ask in an occupational history?
- What is your job?
- What do you do in your job? Tasks? Work with?- chemicals, vapours, fumes etc.
- How long?
- Had any other jobs? What were you exposed to?
- Told that something you use may make you ill?
- Anyone at work had same symptoms?
- Domestic exposure to work agents
- Any hobbies? – Exposure to causes
- Do the symptoms get better away from work?
What is the the role of the GP in assessing fitness to start work?
Rarely invovled
Employers responsibility occupational health service
How can promoting return to work be encouraged in a ‘clinical setting’?
Returning to work should be a key clinical outcome that the success of Tx is measured against
Should be integral part of management plan
How long can you self certify illness for?
What do you need post 7 days?
7 days
Fit Note (AKA Medical Certificate)
What does a fit note do?
•Provide certification for statutory sick pay
- Advise pts about period of sickness absence
- Advise employer about suitable adjustments
- Facilitate return to work through communication w/ Dr’s, Pt’s & Employers
When must the comments box of a fit note be filled in?
What should be included?
If ticked “may be fit to work”
- What can they not do
- Amended duties?
- Altered hours
- Phased return to work
- Workplace adaptations
- Redeployment
Fit note- one other key point: what must you circle?
You must circle if you need to ax the patient again after a period of illness
The Equality Act 2010: Disability Discrimination: What does it say?
Give an example, how should the Ax be done? What should be done in response to this (keep it general)
Disability = Physical or mental impairment that has substantial & long term adverse effects on ability to carry out normal day-to day activities
- Eg: Getting dressed, preparing meal, walking etc..
- Ax: without meds, prosthesis, aids
- Make: Reasonable adjustments so not at disadvantage compared to non-disabled people in workplace.
What is the legal standing with OH serivces?
Are they part of the NHS?
- Not part of NHS
- No legal obligation for employers to provide OH service
What is the role of the OH team?
- Independent & Impartial advice to Employer & Employee
- Investigate &Dx those sick/injured@work
- Assist return to work of sick/ injured @ earliest opportunity
- Match people with jobs appropriate to their: health, fitness & susceptibility status
What is the role of the Health & Safety Executive?
Health and safety executives:
- Enforce the law
- Shape & review regulations
- Produce research & statistics
Department of work and pensions: Access to Work Scheme
What type of help is provided?
- Special aids/equipment
- Adaptations toequipment
- Travel to work
- Travel in work
- MH support service
What are the back pain blue flags in workplace?
- Fear re-injury
- High physically demanding job
- Low expectation return to work
- Low job satisfaction
- Low support
- Lack adjustments
- Poor communication
What should you do when a patient presents with work-related neck and UL disorders?
(think more about the steps)
- Establish anatomical Dx
- Consider work-related risk factors
- Exclude recreation risk factors
Give common examples of Work-Related Neck & UL disorders:
And how they may occur?
- Shoulder pain
- Epicondylitis
- Tenosynovitis
- Non-specific diffuse forearm pain
- Carpal Tunnel Syndrome:
- Prolonged/extreme wrist flexion
- Forceful/ Repetitive wrist movement
- Direct pressure on carpal tunnel
- Hand held vibrating tools
How can work related neck and UL disorders be resolved?
- Improved ergonomics- Work layout, posture to reduce force/ repetition
- Job rotation-Reduced time at repetitive task
- New employee to work @ slower rate initially
- Rest breaks- Allow recovery
- Redeployment- If measure aren’t effective
-
Rehab for affected workers:
- •Reduced hours
- •Reduced work-rate
- •All above
What are the risks and hazards to junior drs?
Hazards: Patients, investigations, therapeutics, environment, biological risk, chemical risks, psychosocial risk
E.g. Biological hazard from infection
Chemical hazard -> aldehydes/ anaesthetics/ antineoplastic drugs
Therapeutics/ physical hazard -> ionising radiation and manual handling
Psychosocial hazard -> working hours/ shift pattern, bullying, hierarchy, workload, stress
