Saliba M-L, Iarmarcovai G, Souville M, Viau A, Arnaud S, Verger P
Inserm U 379, observatoire régional de la santé Provence-Alpes-Côte-d'Azur (ORS PACA), 23, rue Stanislas-Torrents, 13006 Marseille, France.
Rev Epidemiol Sante Publique. 2007 Oct;55(5):376-81. doi: 10.1016/j.respe.2007.07.002. Epub 2007 Sep 4.
Occupational health is a major public health problem in France. However, the level of investment of general practitioners and specialist physicians in this field is not well documented. We aimed at studying elements moving closer or differentiating groups of professionals (notably physicians) in the field of occupational health in terms of conceptions of their roles (prevention and care) and of practices (in particular detection and notification of occupational diseases and perceived barriers).
We conducted a qualitative study in south-eastern France which consisted of in-depth interviews of physicians and actors involved in the prevention of occupational hazards or in their indemnification. Then discourse analysis was carried out on the corpus collected. Content analysis grouped the data into themes.
Several reasons could explain the low investment of physicians in the field of occupational health: insufficient detection of occupational causes of diseases, complexity of administrative procedures of declaration and bias of causal interpretation for the patients exposed to other risk factors such as smoking. The fear that notifying an occupational disease might have repercussions on patients' socio-professional situations places physicians in a situation of ethical dilemma: inducing a social risk on one side, ignoring his rights on the other. Physicians are not sufficiently prepared to deal with these situations, because they lack appropriate knowledge and support from specialists in the field, due to an important bulk-heading of actors and their practices.
To sensitize and train physicians to occupational health and to support multi-field practices are essential.
职业健康是法国的一个主要公共卫生问题。然而，全科医生和专科医生在该领域的投入水平尚无充分记录。我们旨在研究在职业健康领域，专业人员（尤其是医生）群体在角色观念（预防和护理）及实践（特别是职业病的检测和报告以及感知到的障碍）方面趋同或存在差异的因素。
我们在法国东南部进行了一项定性研究，包括对参与职业危害预防或赔偿的医生及相关人员进行深入访谈。然后对收集到的语料库进行话语分析。内容分析将数据归纳为主题。
有几个原因可以解释医生在职业健康领域投入不足的情况：对职业病病因的检测不足、申报行政程序的复杂性以及对接触其他风险因素（如吸烟）的患者因果解释存在偏差。担心报告职业病可能会对患者的社会职业状况产生影响，这使医生陷入伦理困境：一方面引发社会风险，另一方面忽视患者权利。医生没有充分准备好应对这些情况，因为他们缺乏相关领域专家的适当知识和支持，且各行为主体及其实践之间存在严重的分隔。
提高医生对职业健康的认识并对其进行培训，以及支持多领域实践至关重要。
