Harber P
Department of Medicine, University of California, Los Angeles 90024.
Occup Med. 1988 Apr-Jun;3(2):285-98.
In summary, medical evaluation for placement decisions must carefully consider the work requirements and the condition of the individual at the present time and in the future. In all situations, the right of the individual to a job must be balanced against the need to protect the potential worker against any adverse effects. Methods of accommodation of the respiratory-impaired worker must also be considered. As discussed elsewhere in this issue (Chapter 4), there are legal requirements for accommodation of the impaired worker. Accommodation may involve worksite modification, change in work schedule, or change in work practices. Specifically, if an individual cannot meet the exertion requirements of the job, it may be possible to modify them. For example, a punch press operator with chronic obstructive lung disease who is unable to carry the raw materials to the press once a day may be able to work if another worker carries the raw materials or if a suitable mechanical assist device is provided. Furthermore, proper workplace controls can decrease exposure levels; if there is no exposure to a toxic substance, then preexisting disease should not influence placement. In one very provocative study, McGrath demonstrated that with stringent environmental controls, persons with occupational asthma to trimellitic anhydride could continue working safely with this substance. Finally, many persons may be able to work on a part-time basis or during certain shifts. Medical evaluation for proper placement is not a single decision to be made on the basis of a one-time evaluation. An iterative approach may be employed, in which the worker's response to a particular placement may be monitored. In this way, individuals who develop adverse effects will be detected. Follow-up contact between the clinician and the worker in borderline situations should be encouraged both to detect any adverse reactions and to facilitate rapport such that the employee will feel comfortable in relating problems to the clinician. Thus, placement decisions must be made carefully with attention to the many factors involved. Ultimately, the physician must use the best available information when serving as an advisor to the potential employer and to the potential employee.
总之，安置决策的医学评估必须仔细考虑工作要求以及个人目前和未来的状况。在所有情况下，个人的就业权利必须与保护潜在工人免受任何不利影响的需求相平衡。还必须考虑对呼吸功能受损工人的调适方法。正如本期其他地方（第4章）所讨论的，对受损工人的调适有法律要求。调适可能涉及工作场所的改造、工作时间表的改变或工作方式的改变。具体而言，如果个人无法满足工作的体力要求，可能可以对这些要求进行调整。例如，一名患有慢性阻塞性肺病的冲压机操作员，如果无法每天将原材料搬运到冲压机旁，那么如果有其他工人搬运原材料或提供合适的机械辅助设备，他可能仍能工作。此外，适当的工作场所控制措施可以降低接触水平；如果不接触有毒物质，那么既往疾病就不应影响安置。在一项非常有启发性的研究中，麦格拉思证明，通过严格的环境控制，对偏苯三酸酐患有职业性哮喘的人可以继续安全地从事与这种物质相关的工作。最后，许多人可能能够兼职工作或在特定班次工作。为进行适当安置而进行的医学评估不是基于一次性评估做出的单一决定。可以采用迭代方法，其中可以监测工人对特定安置的反应。通过这种方式，可以检测出出现不良反应的个体。在临界情况下，应鼓励临床医生与工人进行后续联系，以检测任何不良反应并促进融洽关系，使员工在向临床医生讲述问题时感到自在。因此，必须谨慎做出安置决定，要注意其中涉及的诸多因素。最终，医生在为潜在雇主和潜在雇员提供建议时，必须使用现有的最佳信息。
