Department of Environmental Medicine and Public Health, Padua University, Padua, Italy.
BMC Public Health. 2010 Jul 9;10:405. doi: 10.1186/1471-2458-10-405.
Rather than a clinical diagnosis, in occupational medicine the critical point is the etiological diagnosis. The first is useful for the therapy, the latter for preventive, epidemiological, regulatory, and insurance measures.
As with causality criteria which are employed in population studies, the answering of four easy questions allows a Primary Care Practitioner to establish a causal link between the work activities and a potential disease that a specific patient may present.After determining the clinical diagnosis and the actual pathology of an occupational disease, the identity, duration, and intensity of the exposure have to be detected for establishing a close-causal effect. The judgment on the occupational origin of the disease requires an integrated approach using multiple sources of information, and goes beyond the clinical diagnosis. This may require consultation with a specialist in occupational medicine.
It is important that the Primary Care Practitioner takes an accurate medical history since this may be the only chance a patient has to have their occupational disease recognised and properly detected/identified. Proper identification of the causative nature of such diseases is important for establishing preventive measures in eliminating and controlling future cases against exposure, epidemiological reporting and studies (particularly in identifying the rates of disease), regulatory reporting requirements and insurance compensation.
在职业医学中,关键的是病因诊断,而不是临床诊断。前者对治疗有用,后者对预防、流行病学、监管和保险措施有用。
与在人群研究中使用的因果关系标准一样,回答四个简单的问题可以让初级保健医生在特定患者可能出现的潜在疾病与工作活动之间建立因果关系。在确定职业病的临床诊断和实际病理后,必须检测接触的身份、持续时间和强度,以确定密切的因果关系。对疾病职业来源的判断需要使用多种信息来源的综合方法,并且超出了临床诊断。这可能需要咨询职业医学专家。
初级保健医生准确地询问病史非常重要,因为这可能是患者唯一有机会让其职业病得到认可并得到妥善发现/识别的机会。正确识别此类疾病的致病性质对于制定预防措施以消除和控制未来的暴露病例、流行病学报告和研究(特别是在确定疾病率方面)、监管报告要求和保险赔偿非常重要。