Occupational medicine

Occupational medicine is the field of medicine dealing in research, teaching and practice with the investigation, evaluation, assessment and influencing the relationships between requirements, conditions and organization of work and the man, his health, his work and employability and its diseases concerned.

• 3.1 Germany
• 3.2 Austria
• 3.3 Other Countries

Special field

These include on the one hand, the prevention and diagnosis of labor or environmental health and occupational diseases. On the other hand, the ergonomic design of workplaces and work processes an essential task, and also the integration of the chronically ill ( such as patients with rheumatism, epilepsy, diabetes mellitus, etc.) and disabled persons in the labor process ( often in collaboration with labor assistants). Industrial and organizational psychology, social medicine, accident prevention and insurance medical and insurance law issues are also among the special features of this medical specialty. Thus, the occupational medicine makes significant contributions to integrated medical care.

Occupational medicine is the classic medical field of prevention, health promotion and rehabilitation. Occupational medicine is thus primarily a consultative medicine and has to meet no curative tasks. She is speaking medicine, that is, focused on the dialogue with the target audience. This is not sick in the majority. In order to have a preventive, occupational physicians, however, may not have to wait ill come to them, but must actively reach out to people.

Fields of activity

The specialist in occupational medicine works as the company doctor or medical industry.

Methods

Occupational medicine is concerned with both the single individual as well as corporate structures and organizational processes.

Are typical for the subject of investigation methods

• Laboratory analyzes, in particular bio-monitoring with regard to hazardous substances ( eg lead, solvents, etc. )
• Standardized or semi- standardized interviews, for example, the determination of the Work Ability Index, job satisfaction, leaving the profession or at the workplace.
• Observation, recording and evaluation of work systems, in particular working conditions, work processes and organizational framework.

Apart from the particularly important for the working medical diagnosis medical history and internal medicine oriented investigation are, depending on the problem, methods from diverse fields added: exercise test, measurement of visual acuity and other ocular parameters, audiometry, spirometry, diagnostic radiology, dermatology, allergy, neurological, orthopedic examination methods and more.

Characteristic is the interdisciplinary orientation in the sense of communication with others, even non-medical fields and their integration in the diagnosis and problem solving.

Medical education and training

Germany

From specialist in occupational medicine in particular, knowledge, experience and skills in the prevention and early detection are demanded of work-related and health -related disorders, occupational diseases and the inducing toxicants including epidemiological basics. The core of the department include the health advice including vaccinations, workplace health promotion, including individual and group-related training, consulting and planning issues in the technical, organizational and personal occupational health and safety and accident prevention and occupational safety. Management knowledge and skills are required especially in the development of strategies for emergency medical services at work ( including the organization and ensuring first aid ) and in the development of operational concepts for prevention ( Health Management ).

The model further training of Procedure of the German Medical Association also lists in detail:

• Participation in medical, vocational and social rehabilitation
• Occupational rehabilitation and use of the chronically ill and vulnerable persons in the workplace
• Evaluation of performance, resilience and operability including work physiology
• Occupational and environmental hygiene, including occupational medical toxicology
• Labor and industrial psychology including psycho-social aspects
• Preventive medical, suitability and aptitude tests including transport medical questions
• Basics of hereditary diseases including indications for genetic counseling
• Indication, proper specimen collection and handling of laboratory tests including biomonitoring and occupational medical evaluation of the results
• Medical examination for work-related illnesses and diseases, assessment of labor, professional and earning capacity, including questions of changing jobs
• Occupational medical examination of the environmental factors and their evaluation in terms of their relevance to health
• Occupational medical examinations under laws
• Workplace assessments and risk analyzes
• Discussions on ergonomic work design
• Occupational medical evaluation of measurement results of different work environment factors, such as noise, climate sizes, lighting, hazardous materials

The training time is 60 months. More pictures and a training center must be authorized by the General Medical Council (ie allowed) to be. Of the 60 months, 24 months in internal medicine and general medicine to make 36 months of occupational medicine. In occupational medicine, up to 12 months will be deducted from other areas.

As a special feature, a 360 hours of comprehensive course on special topics such as occupational diseases, occupational psychology, physiology, ergonomics, assessment, law, business, engineering, social security system must be completed during the occupational health specialist training. The organizers are the academies of Occupational and Environmental Medicine in Bad Nauheim, Berlin, Bochum, Dresden, Dusseldorf, Munich and Ulm / Stuttgart.

In addition to the Specialist title occupational medicine there is also an additional qualification in occupational medicine. She was a forerunner of occupational medicine and is still used today by the German Medical Assembly, because it is assumed that a very great need for operational medically active physicians, especially for the care of countless small businesses exist and these requirements at present by specialists in occupational medicine alone can not cover was.

The additional designation Occupational medicine presupposes an already existing Board certification in an area of direct patient care. Thus, almost every specialist can acquire this additional qualification in a one-year, full-time training. As with the specialist medical training participation (see above) certified at the 360 hour course. According to the recommendation of the 107th German Medical Tags (2004), the curriculum for the additional designation Occupational medicine should include training 36 months, including 12 months internal medicine or general medicine and 24 months of work medicine. Due to the sovereignty of the state medical boards vary for operational medicine, however, the requirements for the training depending on the province. In Baden- Württemberg, Bavaria, Lower Saxony, North Rhine and Schleswig -Holstein, the training time includes at an approved occupational physicians only 12 months, Westphalia -Lippe calls for 18 months, in Bremen, Mecklenburg -Western Pomerania, Rhineland -Palatinate, Saarland, Saxony -Anhalt and Thuringia are 24 months training required. In Berlin, Brandenburg, Hamburg, Hesse and Saxony will provide training in an additional qualification in occupational medicine is not possible. Some medical associations and physicians get with the additional designation operating a medical training authorization.

Austria

In Austria the work of the Medical Academy in Klosterneuburg, Linzer Academy of Occupational Health and Safety Technology and since February 2013, the Vienna Academy of Occupational Medicine and Prevention form ( WIAP ) Doctors to occupational physicians continue.

Occupational medicine training is based on the study of medicine and the cycle or specialist training. The training objectives are in particular in recognizing health and performance of relevant influencing factors on physique and psyche of people in the company, in the evaluation of the impact of these factors on health and performance of the employee (s ) in the development and implementation of improvement measures and in the clarification of individual health disorders in terms of their potential work-related causes.

Other countries

Uniform specialist medical qualifications are available in Europe for the following countries:

• Belgium: médicine du travail (Wallonia) / arbeidsgeneeskunde (Flanders)
• Denmark: samfundsmedicin / arbejdsmedicin
• Germany: specialist in occupational medicine
• Finland: työterveyshuolto / företagshälsovård
• France: médecine du travail
• Greece, Great Britain (United Kingdom): occupational medicine
• Ireland: occupational medicine, Italy: medicine del lavoro
• Iceland: atvinnulækningar
• Luxembourg: médecine du travail / Aarbechts - Medezin
• Netherlands: There have en gezondheid: bedrijfsgeneeskunde / s There have gezondheid: verzekeringsgeneeskunde
• Norway: arbeidsmedisin.
• Austria: Specialist in labor and industrial medicine
• Poland: medycyna pracy, Portugal: medicina do trabalho
• Sweden: yrkes -och miljömedicin
• Spain: Medicina del Trabajo

For the mutual recognition of a comparable specialist training is required. This is officially governed by Directive 2005/35/EC, which must be mutually recognized within the EU Member States. It should be noted here, however, that the considerable variations between training regulations from different EU countries to some extent. For example, take the specialist training in Belgium and the Netherlands four years, and you do not have - in contrast to the German-speaking countries - have worked in the hospital. The activities are sometimes different. A specialist in the Netherlands and Belgium, for example, leads not by ergometry, but refers the patient to a cardiologist. The Dutch occupational physicians also got the task to assess the work ability of workers. He will thus also a function that is in Germany Subject to the medical service of health insurance (MDK ). Furthermore, the Dutch insurance physicians may ( gezondheid There have en: verzekeringsgeneeskunde ) according to EU directive called specialist in occupational medicine and act as occupational physicians in other EU countries. But to what extent could find a job, a specialist in occupational medicine in another Member State of the EU, is doubtful, mainly because the legal situation in the different countries is different. The practical activities and courses are often quite different.

In the U.S., qualifications and quality assurance in occupational and environmental medicine from the medical professional society American College of Occupational and Environmental Medicine ( ACOEM ) to be perceived, as there is generally customary for the medical activity. A detailed curriculum is mandatory for the recognition by the ACOEM.

Legal Significance

The OSH Act requires every employer in Germany, to provide adequate occupational health services to its employees. It covers all necessary for the prevention of work -related health hazards occupational health measures.

The Hazardous Substances Act defines the term occupational medical detail. It includes in particular

• The assessment of the working conditions
• The education and counseling of employees
• Special occupational medical examinations for early detection of health problems
• Professionally based recommendations for the design work
• The further development of occupational health and safety through the knowledge gained

For more information, Regulation on occupational health care ( ArbMedVV ) and also the law on occupational physicians, safety engineers and other professionals for Occupational Safety ( Occupational Safety Act - ASiG ). It determines, among other things, that only professionally qualified doctors may be entrusted with the occupational health care by the employer. Scope and tasks of occupational health care governs the accident prevention regulation DGUV ​​V2 statutory accident insurance institutions.

Special screening examinations are mandatory for certain loads, eg from hazardous substances or noise. The professional associations and other statutory accident insurance companies have issued a series of so-called investigation principles. These are recommendations and are intended to give the state of the science according to indications of occupational medical examinations.

Definitions and regulations of the Hazardous Substances Regulation, frequently used as guidance for the current reorganization and other aspects of employment protection legislation.

History

Already in ancient Egyptian sources, as the Ebers Papyrus (1500 BC ) is reported to dust lung diseases. When processing the stones for the great monuments of the resulting dust inhaled by the stonemasons and damaged their lungs.

Work-related diseases are the differential diagnosis to be considered from time immemorial by the doctor. Hippocrates ( 460-377 BC) emphasized that was to pay close attention to occupational factors in the collection of medical history.

The Roman writer Pliny (78 BC) provides detailed recommendations for the prevention of black lung disease.

In Renaissance Europe we are interested with the resurgence of scientific observation increases for the relationship between work and health. The doctors Paracelsus (1493-1541) and Agricola (1494-1555) to investigate the diseases of miners, mountain addiction called arsenic, lead and mercury poisoning. Bernardino Ramazzini (1633-1714) published in 1700, with his work De morbis artificum diatriba the first complete presentation of important diseases of 40 occupational groups.

Industrialization brings work-related diseases by allowing their research, treatment and prevention, the physicians must devote themselves. In 1839 the first " OSH Act " in Prussia is adopted. Bismarck set in 1884 by the first accident insurance law in the new German Empire, with the trade associations are created.

1912 founded in Berlin in the Kaiser Wilhelm Institute for Occupational Physiology. Following the closure during the Second World War, it is established as the Max Planck Institute in Dortmund again. Under the leadership of Ernst Wilhelm Baader is established in 1924, Clinic for Occupational Diseases in Berlin. It is extended to 1933 University Institute.

The term occupational medicine is introduced in 1929 by the " Permanent Commission for occupational diseases and industrial hygiene " of the World Health Organization in official parlance.

As early as 1958, in the former GDR occupational hygiene mandatory school subject, consist of all medical higher education institutions independent chairs. The occupational medical care of employees is centralized in many areas, eg in the medical service of the transport system of the GDR. In the Federal Republic of Germany (FRG) occurs in 1974, the law on occupational physicians, safety engineers and other professionals for Occupational Safety ( Occupational Safety Act ) came into force in 1996, the Occupational Safety and Health Act as the national implementation of the relevant EU requirements. After 1990, the established in Germany dual system of labor protection is also transferred to the new federal states.

Like the rest of today's world of work is subject to constant change and occupational medicine. Physical stress in the workplace kick back, psychomental take. Environmental medical issues have grown in importance. In place of routine examinations because of exceedances occur consulting, education and training tasks that provide some completely new demands on qualifications and roles of the operating physician.