Divided loyalties in medicine: the ambivalence of occupational medical practice.

This paper develops two divergent views of occupational medicine. The first holds that the field has a major contribution to make in the prevention of disease and the stabilization of health care costs. The second sees in it all the worst characteristics of contemporary medical practice. Consideration of the special difficulties of occupational physicians raises fundamental questions about the divided loyalties and moral conflicts that will increasingly beset the general practice of medicine as bureaucratic forms and controls continue to proliferate.