Role of medical screening in the prevention of occupational disease.

Some occupational medical screening programs are designed to detect adverse health effects of workplace hazards and to complement environmental control programs. Often, programs are developed using the approach of clinical practice, and procedures are not adequately standardized. The logic that guides this decision making is not well developed, thus limiting the ability of occupational health practitioners to make defensible decisions regarding the management of individual workers at risk. Although the programs are, in theory, constructed to benefit the worker, little thought has been given to standardization of data collection and to using the medical information that is obtained. Currently, the National Institute for Occupational Safety and Health (NIOSH) is developing recommendations to present to the Occupational Safety and Health Administration to be used in the development of a "generic approach" to screening. These recommendations will include guidelines for threshold exposure levels for screening, rosters of screenable health effects to be targeted, algorithms linking exposure and effects, criteria for test result evaluation, plans for courses of action after testing, and procedures to ensure confidentiality. NIOSH's comprehensive approach to developing occupational screening programs should benefit employees, employers, the scientific community, and the community at large.