In the early 1990s, as a medical student in a large Scottish teaching hospital, I asked a patient, " What is your occupation? ” I was cautioned by the teaching consultant to treat every patient the same way: to ask a patient's occupation was risking a prejudicial approach to the practice of medicine.
How different the Italian father of occupational medicine, Bernardino Ramazzini (1633-1714) who advised:
‘ When you come to a patient’s house, you should ask him what sort of pains he has, what caused them, how many days he has been ill, whether the bowels are working and what sort of food he eats. So says Hippocrates in his work Affections. I may venture to add one more question: what occupation does he follow? ’
[ De Morbis Artificum Diatriba ‘Diseases of Workers’, 1700 ]
It was after attending the Glasgow diploma in occupational medicine course (DOccMed) ten years later - some fifteen years ago - that I began routinely asking patients my two favourite questions:
“ What is your job? ” and “ Can you describe what you actually do? ”
I believe having the DOccMed has made me a better GP. And being a GP (of the self-employed, independent contractor variety - with employees) has given me experience of the commoner clinical and employment scenarios I’m presented with in occupational medicine. Our attached medical students from Aberdeen University also get a taster of what it's like to have a portfolio career.
The DOccMed has opened up a number of avenues beyond routine NHS work, which makes my professional life as a doctor varied and more interesting. I've been an Approved Doctor with the Maritime and Coastguard Agency for ten years, doing health surveillance medicals for merchant seafarers. I also provide independent medical assessments for the motor car repairs industry, and Hand-Arm Vibration Syndrome (HAVS) assessments - mainly for workers in the electric power sector, and also for whisky distillery workers. I work two half days in occupational medicine per week - as does another GP in my practice. The fees companies typically pay are reasonable, and enough to keep other GPs in the partnership sweet.
In the past, I did routine medicals for off-shore oil and gas workers; assessed bus and coach drivers; provided pre-employment and sickness absence medicals for a large call centre; was occupational physician to a large Highland estate; and I have seen employees from various National Care Home providers.
Despite the detailed knowledge and breadth of skills required for practising Occupational Medicine, the specialism is sometimes dismissed, by Hospitalists and GPs alike, typically as “ Occy Health ”. Perhaps somewhere you go for your hep B vaccinations? Regardless, I have successfully encouraged two Highland GPs into obtaining the diploma, and another two are currently committed to Faculty of Occupational Medicine approved DOccMed courses this year. I have also advised these GPs to join the Society of Occupational Medicine to support their development through the DOccMed, and beyond. For those of you on Twitter, I’d recommend following the faculty @FOMNews and the society @SOMNews. The respective websites are www.fom.ac.uk and www.som.org.uk .
A final anecdote. In May this year, I witnessed a motivational exchange during the Glasgow Occupational Lead Exposure Surveillance course. A GP introduced herself as " dipping a toe " into occupational health, to which Professor Ewan Macdonald spontaneously replied:
" Welcome to what is undoubtedly the most interesting branch of medicine! "
So says Professor Macdonald. I may venture to add one more encouragement to all GPs:
“ ... and Occupational Health is especially rewarding when combined with your role as a General Practitioner. ”
By Dr Iain Kennedy (GP and Occupational Physician, Inverness)