Pachman Joseph
Centre of Continuing Studies, University of Connecticut, Storrs, CT 06269, United States of America.
Bull World Health Organ. 2009 Jul;87(7):529-34. doi: 10.2471/blt.08.052605.
This paper examines the evidence base for the use of pre-employment/pre-placement medical examinations. The use of pre-employment examinations is often driven more by cultural practices than evidence. There is a lack of evidence on their effectiveness in preventing health-related occupational risks. Hypertension screening is highlighted as a common pre-employment practice for which there is no standardized criteria to use to determine fitness for work. There are inherent problems in screening for psychiatric disorders and substance abuse as well as potential for racial bias and other unintended negative effects. This paper questions the economic case for this practice and also expresses concerns about paternalism related to identified risk factors. Health assessments should only be included when appropriate to the task environment and the general use of pre-employment exams and drug screening should be eliminated. Generally, a health assessment by questionnaire should suffice. Occupational health providers should advise against the application of physical or mental standards that are not relevant to fulfilment of the essential job functions. Consensus development regarding best practice, as well as consideration for acquiring outcome data related to pre-employment practice, is recommended.
本文探讨了入职前/上岗前医学检查的证据基础。入职前检查的使用往往更多地受到文化习俗的驱动，而非证据的支持。缺乏关于其预防与健康相关职业风险有效性的证据。高血压筛查被强调为一种常见的入职前检查做法，但没有用于确定工作适应性的标准化标准。在筛查精神障碍和药物滥用方面存在固有问题，以及存在种族偏见和其他意外负面影响的可能性。本文质疑这种做法的经济合理性，并对与已识别风险因素相关的家长式作风表示担忧。仅在适合任务环境时才应进行健康评估，应取消入职前检查和药物筛查的普遍使用。一般来说，通过问卷调查进行健康评估就足够了。职业健康提供者应建议不要应用与履行基本工作职责无关的身体或精神标准。建议就最佳实践达成共识，并考虑获取与入职前实践相关的结果数据。
