Our purpose in writing this book is to provide general guidelines for the creation, development, and management of an occupational health service, with an emphasis on basic medical and nursing services. We have attempted to meet a particular need for a description of the possible settings in which such care can be given and the prevention of occupational disorders can be implemented. Our book is intended for the use of physicians in solo or group practice, medical directors of corporations, plant physicians, occupational health nurses, and the managers of companies, plants, public agencies or health care facilities alike. It serves a dual purpose, as a reference to consult in case of problems and a road map to follow in entering unfamiliar territory. Like any road map, however, this one does not detail every house, alley, and country road. Certain generalizations are, therefore, inevitable and most of the suggested approaches should be adapted, as appropriate, to the local situation. Those parts of the guide that deal with the nuts and bolts of the service may be negotiable; those sections dealing with ethics and basic requirements of the service are less open to interpretation.
The specific objectives of this guide can be summarized as follows:
The contents of this book should be indispensable in the task of developing an occupational health service but there is no substitute for individual experience, reviewing successful models at first-hand, and careful planning. Much can be learned that will be useful in the future by keeping accurate records of why certain policies and procedures are adopted and why certain alternative were chosen. Too often, such important information is lost when a key person leaves the organization and mistakes are then repeated. Careful planning cannot be stressed enough for the essential aspects of the service, such as location, staffing, budgeting, organization, and quality assurance, but inevitably mistakes will be made. Most will not be disastrous, just annoying. A healthy tolerance for the minor problems will help in solving the major ones.
This book was written to facilitate the introduction and development of occupational health services and to provide a single source for the definition and, the authors hope, resolution of common problems. Readers are also urged to gain first-hand experience by arranging to tour the facilities of a variety of employers in a variety of industries both within their community and outside, and to visit selected clinics, both the good and the not-so-good, in order to learn first-hand the limitations as well as the benefits of different approaches to common problems. In the true spirit of professionalism, problems should be recognized, studies, and the lessons shared with others so that they will not be repeated blindly.
Finally, we would like to acknowledge the assistance of students and colleagues who contributed ideas or who reviewed preliminary drafts: Dr. M. Joseph Fedoruk, Dr. Brady C. Hartman, Dr. Phil Jacobs, Dr. David F. Goldsmith, Dr. Colin Soskolne, Michael Doering, Carol Jane McNutt, and Joyce Zechter. Also, we thank those journals and publishers which allowed the use of figures or tables from our prior publications and which permitted us the opportunity to develop some of these ideas in earlier articles: Annals of Internal Medicine, the Canadian Medical Association Journal, the American Family Physician, the Journal of Occupational Medicine, Seminars in Occupational Medicine, and the American Journal of Industrial Medicine, as well as the American Academy of Family Practice and the Joint Curriculum Development Project in Preventive Medicine of the Association of Teachers of Preventive Medicine and the Center for Educational Development in Health, Boston University. No set of acknowledgements would be complete, however, without extending recognition to two outstanding secretaries, Mrs. Kathy Lasell and Ms. Debbie Sullivan, who worked tirelessly and attentively on this difficult manuscript.