Occupational History Taking Flashcards
Common questions to explore occupational health issues
Beginning the Consultation
Good morning. I am Dr Nina Dalton, one of the one of the Occupational Health registrars.
- To begin with, could you confirm your full name and date of birth?
- What would you prefer for me to call you?
- Were you aware of the referral being made, and are you happy to continue?
Introducing the Role of OH
- Do you understand the role of Occupational Health, or would you like me to provide further information?
- Occupational health focuses on promoting and maintaining the physical, mental, and social well-being of employees such as yourself, by identifying and managing workplace health risks.
- This occupational health assessment will evaluate how your health may be affected by your work and vice versa
- It will allow me to provide impartial advice and recommendations to yourself and your employer to prevent or manage health issues, and also advise regarding your on-going fitness to work
- My recommendations will be shared between yourself and your manager in the form of a written report. Medical confidentiality applies to our discussions and OH records
- Do you have any questions? Do you consent do me continuing the consultation?
Asking about Occupation
- Can you tell me about what you do for work?
- What do you do in your job? Can you tell me more about the different activities you do in your working week?
- How long have you been doing that for? How much time do you spend doing xxxx activity?
- How many hours do you work? Night shifts? Breaks?
- Do you have any other jobs? Any hobbies? e.g. DIY
- Have you had any other previous jobs or hobbies?
- Do you work with any chemicals?
- What are the names of the chemicals? Do you have a photo of the label or materials safety data sheet?
- Do you smoke? Have you ever used recreational drugs?
Linking health issues to work
- When did xxxxx start?
- Have you noticed any relation to your work?
- Is xxxxx exacerbated by your work?
- Do you notice any improvement in xxxxx on your days off? Is there improvement when you have a holiday?
- Is anyone else at work experiencing similar issues? Do other people who use xxx exposure also experience similar problems?
- Do you have any ideas about what could be causing your symptoms? Is there anything you are particularly concerned about? is there anything in particular you’d like me to do to help?
Asking about sound and hearing
- Could you hear / have a conversation with the person next to you?
- How long were you exposed to such sound?
- Did you have any protection for your hearing?
Asking about exposure to chemicals/dust?
- Do you know the name of the chemical?
- How often do you work with this substance? For how long?
- Is the dust so concentrated that it is difficult to see through it?
- Do you wear any protective clothing / equipment / ventilator?
- Do you know the name / type of mask that you wear? Has your employer tested the fit of this mask?
- Is there a ventilation system / are you able to open windows?
- Is there anyone at work who is responsible for managing this / maintaining ventilation systems / ensuring adequate provision of PPE?
Questions about the workplace
- Have any adjustments to your role been made so far?
- Does your workplace have anything in place to minimise exposure to hazardous substances?
- Is there anyone who is responsible for work place health and safety?
Other questions to ask
- Do you have any other health conditions?
- Any previous major medical illnesses?
- Any previous surgeries?
- Are there any health conditions for which you see your health provider regularly?
- Do you take regular medication?
- Any allergies?
- Any over the counter medications?
- Can you tell me about your home situation? Do you live with anyone at home?
- Do you drink any alcohol? Do you smoke cigarettes? Do you use any recreational drugs?
- How is your diet and nutrition?
- Do you have any difficulties with hearing or vision?
- Are there any conditions that run in your family?
- How is this affecting you?
Respiratory History questions
- Do you experiencing coughing, wheezing or shortness of breath?
- If cough, is it productive? Colour of sputum, blood in sputum?
- Have you ever had any episodes of chest tightness, as though you are not able to get in enough air?
- How long has this been going on for? Have you noticed that your symptoms are progressing? Is this affecting your daily living?
- Have you noticed any relation between your work and symptoms?
- Is there improvement in your symptoms during holidays and weekends?
- Is anyone else at your workplace affected / experiencing similar issues?
- Do you work in environments with dust, fumes, gases or chemicals? Do you know the name / have a safety data sheet?
- Do you know if there are any protections in place to help minimise exposure to this e.g. ventilation system?
- Do you wear personal protective equipment, such as respirators or masks? Do you know what kind of mask?
Past Medical history:
- Have you ever been diagnosed with any other respiratory illnesses such as asthma or COPD?
- Have you ever previously had a lung infection
- Smoking history?
- Family history of lung disease?
Respiratory History OH recommendations?
Employee:
- For this employee, it would be helpful to refer for spirometry
- Consider bloods e.g. FBC, ESR, serum preciptants, serum IgE + imaging e.g. CXR + HRCT
- Consider referral to Respiratory physician with interest in occupational lung disease
- Review role and whether it would be helpful to have amended duties to minimise exposure to the causative substance
- Offer phased return to work
- Ensure medical surveillance in place if high risk industry e.g. mining, construction, chemical industry
- Referral for smoking cessation programme as smoking exacerbates respiratory conditions
Risk Assessment:
- I would ideally like to do a workplace visit to help me identify and assess workplace exposure to respiratory hazards, such as dust, chemicals and fumes
- This would also allow me to assess control measures already in place (such as ventilation, use of PPE)
- This will help with risk assessment
Workplace Modifications:
- Implementing control measures such as elimination, substitution, engineering controls e.g. exhaust ventilation systems, PPE
- Ensure PPE is appropriate for use, well-fitted and effective
Minimize exposure to harmful substances by implementing control measures (e.g., improved ventilation, dust suppression).
Occupational Dermatology History questions?
- What seems to be the issue? Rash? Itching? Discharge? Bleeding? Pain? Blistering? Progression?
- Any systemic symptoms - fever? Weight loss? reduced appetite? Joint pain?
- Any previous episodes? Anything that has helped in the past?
- Time course? Location? Anything makes it better or worse?
- Is this having a wider impact on you e.g. mood, confidence, functioning?
Occupational questions:
- Have you worked with any chemicals, solvents, or substances known to irritate or damage the skin (e.g., detergents, adhesives, oils, or cleaning agents)?
- In your work are you exposed to extremes of temperature? Humidity? Wet environments?
- Have you ever experienced your symptoms after work? Do symptoms improve during holidays / free time?
PMHx:
- Any history of eczema, psoriasis or other skin conditions?
- Do you have asthma or any allergies?
FHx:
- Are there any skin conditions that run in the family?
Dermatological History recommendations?
- PPE: gloves, clothing, protective clothing to minimize skin contact with irritants
- Hygiene practices: proper hand washing, use of emollients to address dryness and irritation
- Provide employees with access to skin care products
- If severe, for referral to Dermatologist with special interest in occupational skin conditions
- Could consider amending duties + phased return to work
Work place modifications:
- Workplace visit to evaluate work processes and skin exposure risks + current control measures in place
- Suggest safer alternatives, if possible
- PPE as above
- Regular dermatological assessments for workers with high-risk exposures (e.g. lab tech, cleaners, construction)
- Education of workers re: early signs of dermatitis and other skin conditions
Vision history questions?
- Can you tell me more about your symptoms?
- Blurred vision? Eye pain or strain? Flashers / floaters? Worsening in visual acuity? Headaches? Dry eyes?
- Time course? Worsening? Associated with work?
- Do you work with screens, machinery or lighting that could strain your eyes?
- Exposure to high intensity light e.g. welding, lasers?
- Hazardous materials / chemicals that could affect vision?
- Does your workplace provide any protective eye wear? Do you get filters? Goggles?
- How is this impacting you? Function? Ability to do role?
PMHx:
- Any previous issues with eyes or visual problems? Short / long sightedness, astigmatism
FHx
- Any family history of visual problems?
Occupational Health Vision recommendations?
- Assessment of visual acuity using a snellen chart
- Referral for optician assessment
- Consider referral for ophthalmology assessment
- Reasonable adjustments: providing material in large print format/braille/on laptop if patient cannot see screen in distance
- Change in role to minimize exposure +/- role that is not sight-critical
- Regular eye exams for surveillance e.g. for employees working with screens or in hazardous environments
- Screen workers for digital eye strain
Workplace adaptions
- Ensure adequate lighting
- Encourage frequent breaks
- 20-20-20 rule: every 20 mins look at something 20 feet away for at least 20 seconds
- Provide protective eyewear for workers in high risk environments (e.g. welding, lab work, chemical work, bright light)
Hearing history assessment questions:
- Can you tell me more about the difficulties with your hearing?
- How long has this been going on for? Getting worse?
- One ear or both ears? Any other symptoms such as headaches or dizziness?
- Have you noticed tinnitus / a ringing in your ears?
- Do you regularly use equipment that emits high levels of sound such as machinery or power tools?
- Do you work in a loud environment?
- Would you struggle to have a conversation with someone if they were standing within 2 metres of you?
- How is this affecting you?
- Do you wear hearing protection at work such as ear plugs or ear defenders?
Past Medical history:
- Have you ever previously had any problems with your ears or hearing? Previous ear infections / meningitis / meniere’s?
FHx:
- Is there any family history of hearing impairment?
Hearing OH recommendations:
- Referral for audiology assessment
- If hearing loss for reasonable adjustments to work role so that patient is not exposed to loud sounds / hearing not critical for role
- Ensure manager / HR is aware. Patient is empowered to ask if they have not heard something
- During meetings, try to sit person in direct line of site to allow lip reading
- Try to provide written handouts, so person can read
- Hearing loops if need for hearing aids
- Try to provide quiet work environment to make it easier for person to hear and engage in workplace discussions
Workplace visit:
- Can control measures be implemented to mitigate risk to hearing (e.g. elimination, substitution, engineering controls, administrative controls, PPE) e.g. sound dampening/barriers, quieter machinery
- Is appropriate PPE in the form of ear plugs or ear defenders provided to staff?
- Is there education and training on the risks and correct use of PPE?
Surveillance:
- If high risk industry should be baseline audiometry assessment for new joiners
- Thereafter for annual audiometry assessment for first 2 years
- Following this for 3 yearly audiometry assessments
Musculoskeletal history questions?
- Whereabouts is the pain? When did it start? What is the pain like? Does it move anywhere or is it located just in one place?
- Has the pain been worsening or has it stayed the same? Is it there all the time?
- Is there anything that makes it better or worse?
- Swelling? Stiffness? Deformity? Locking?
- Any systemic symptoms? Any fever? Lethargy? Reduced appetite? Night sweats?
- Do you perform any repetitive movements? Any heavy lifting? Any work in awkward positions (e.g. bending and twisting)?
- Have you experienced any back pain, joint stiffness or muscle strains at work?
- Do you have any history of musculoskeletal disorders such as herniated discs, tendonitis or arthritis?
- Are there any ergonomic adjustments made in your workspace to reduce strain (e.g., adjustable chairs, desks, or lifting devices)?
Musculoskeletal OH recommendations?
- Simple analgesia (e.g. NSAIDs)
- Reassurance
- Encourage to remain active
- Consider need for splinting
- Consider need for imaging e.g. XR or MRI
- Consider need for referral to Orthopaedic service
- Implement ergonomic assessments for employees who perform repetitive tasks or heavy manual labor.
- Encourage the use of ergonomically designed tools, chairs, and workstations.
- Encourage regular breaks, stretching exercises, and strengthening programs to reduce the risk of musculoskeletal injuries.
- Monitor for early signs of musculoskeletal disorders and intervene early with treatment or adjustments to reduce strain.
Mental Health history questions?
- How has your mood been recently?
- Have you felt low in mood recently?
- Have you felt less pleasure or interest in doing things?
- Have your energy levels been lower than normal?
- Has there been any change to your sleep?
- Has there been any change to your appetite or weight?
- Has it been difficult to concentrate?
- Have you thoughts seemed slower than normal?
- How do you feel about the future?
- Have you ever felt yourself to be worthless?
- Have you ever had any thoughts about harming yourself?
- Have you ever had any thoughts about ending your life? Do you have a specific plan?
- Is there anything that is stopping you?
- Do you experience significant stress or pressure at work?
- Are there aspects of your job that cause you anxiety?
- Have you noticed any changes in your work performance?
- Do feel as though you have a good balance in your work and life at present?
- Have you ever previously been diagnosed with depression, anxiety or any other mental health conditions?
- Have you ever seen a psychiatrist?
- Have you ever received therapy or counselling in the past?
Mental health OH recommendations?
- Further explore symptomatmology
- Use of a validated tool to classify severity
- Beck depression inventory or PHQ-9
- Perceived stress survey
- Maslach Burnout inventory
- Workplace stress questionnaire
- Copenhagen Psychosocial Questionnaire
Stress Management Programs:
Offer access to employee assistance programs (EAPs) for counseling and mental health support.
Implement stress-reducing programs, including mindfulness, relaxation techniques, and time management workshops.
Workplace Support:
Foster a supportive work environment with clear communication, regular feedback, and manageable workloads.
Flexible Work Options:
Promote flexible working arrangements (e.g., remote work, flexible hours) to help employees manage stress and improve work-life balance.
Mental Health Surveillance:
Regularly assess workplace stress and mental health risks through surveys or one-on-one check-ins.
Promote a culture where mental health is treated with the same importance as physical health.
Occupational respiratory differential
- Occupational asthma
- Chronic Obstructive Pulmonary disease
- Pneumoconioses
- Hypersensitivity Pneumonitis / extrinsic allergic pneumonitis
Occupational Musculoskeletal differential?
- Repetitive strain injury
- Carpal Tunnel syndrome
- Occupational lower back pain
- Tendinitis or bursitis
Occupational dermatological differential?
- Occupational contact dermatitis
- Occupational eczema
- Psoriasis
- Skin cancer
Occupational hearing problems?
- Noise-induced hearing loss
- Tinnitus
- Acoustic neuroma
- Barotrauma
Occupational visual problems?
- Computer Vision Syndrome (CVS): Affects individuals who spend prolonged periods in front of computer screens, leading to eye strain, dryness, blurred vision, and headaches.
- Refractive errors: Myopia (short-sighted), Hyperopia (far-sighted), Astigmatism, Presbyopia (age-related inability to focus nearby due to reduced accommodation)
- Cataracts: Prolonged exposure to UV radiation, such as in outdoor workers (e.g., construction, agriculture), can increase the risk of developing cataracts.
- Retinal Damage: Exposure to high-energy visible light or lasers in certain professions (e.g., manufacturing, laboratory work) can lead to retinal damage or vision problems.
- Glaucoma: Some occupations with high levels of stress (e.g., air traffic controllers, drivers) have been associated with an increased risk of glaucoma.
Occupational Psychiatric problems differential?
- Workplace Stress and Anxiety: Caused by high job demands, poor work-life balance, harassment, or job insecurity.
- Depression: Chronic stress, long working hours, poor workplace culture, and job dissatisfaction are common contributors to work-related depression.
- Post-Traumatic Stress Disorder (PTSD): Can occur in workers exposed to traumatic events, such as emergency responders, healthcare workers, or military personnel.
- Burnout: A state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress, often seen in high-demand occupations like healthcare, teaching, or social work.
Anxiety questions?
- When did this begin? Is it worsening?
- How does you body feel when you are anxious?
- Have you ever experienced a panic attack?
- Is there anything you have noticed brings on / triggers your symptoms?
- Is there anything you have found that settles the anxiety?
- Is this affecting your daily functioning? Your ability to do your work?
- Any effect on your sleep, energy levels or appetite?
PTSD questions?
- Have you experienced any traumatic events?
- Do you ever get flashbacks?
- Do you ever get intrusive thoughts?
- Do you ever have nightmares?
- Have you noticed any changes to your mood or personality? Feeling emotionally blunted or more angry irritable?
- Are you hypervigilant?
PTSD Management:
- Identify any occupational stressors that may exacerbate PTSD, such as high workloads, trauma-related incidents at work, or lack of social support.
- Psychological Interventions: trauma-focused CBT, is the gold standard treatment for PTSD. It helps individuals process trauma, reduce avoidance behaviors, and manage distressing thoughts.
- Eye Movement Desensitization and Reprocessing (EMDR) is another evidence-based therapy that may be effective in PTSD treatment.
- Pharmacotherapy: Selective serotonin reuptake inhibitors (SSRIs), such as sertraline and paroxetine, are first-line medications for managing PTSD symptoms, particularly for depression and anxiety.
Short-term use of benzodiazepines may be considered for acute anxiety, but long-term use is generally avoided. - Workplace Adjustments: Gradual return to work: Phased reintegration, allowing the individual to return part-time or to modified duties if necessary.
- Reasonable accommodations: These may include flexible working hours, reduced workloads, or a change in the physical work environment to reduce triggers.
- Confidentiality: Ensure sensitive information is protected and that the employee feels supported without stigma.
- Ongoing Support: Encourage ongoing counseling or support through employee assistance programs (EAPs).
- Regular monitoring of the employee’s progress and well-being, ensuring appropriate adjustments are maintained as recovery progresses.
