Occupational medicine

from Wikipedia, the free encyclopedia

The occupational medicine is the field of medicine , which engage in research, teaching and practice with the investigation, evaluation, assessment and influencing the interactions between requirements, conditions and organization of work and the people, his health, his work and employability and its diseases deals. Former names for this medical field of activity were industrial hygiene and industrial pathology .

Area of ​​Expertise

On the one hand, this includes the prevention and diagnosis of work- or environmental-related health problems and occupational diseases . On the other hand, the ergonomic design of workplaces and work processes is an essential task, as is the integration of the chronically ill (such as patients with rheumatism , epilepsy , diabetes mellitus etc.) and people with disabilities in the work process (often in cooperation with work assistants ). Industrial and organizational psychology , social medicine , accident prevention and insurance- medical and insurance law topics are also among the special features of this medical specialty. In this way, occupational medicine makes a significant contribution to integrated medical care .

Occupational medicine is the classic medical specialty of prevention, health promotion and rehabilitation . Occupational medicine is therefore above all an advisory medicine and has no curative tasks to fulfill. It is speaking medicine , that is, geared towards dialogue with the target group. Most of them are not sick. In order to be able to have a preventive effect, however, occupational physicians must not wait for the sick to come to them, but rather have to actively approach people.

Fields of activity

The specialist in occupational medicine works as a company doctor or trade doctor .

Methods

Occupational medicine deals with the individual as well as with operational structures and organizational processes.

The examination methods typical for the subject include

  • Laboratory analyzes, in particular biomonitoring with regard to hazardous substances (e.g. lead, solvents, etc.)
  • standardized or semi-standardized surveys , for example the determination of the workability index , job satisfaction , length of stay at work or at the respective workplace.
  • Observation, recording and assessment of work systems , in particular working conditions, work processes and organizational framework conditions.

In addition to the medical history , which is particularly important for occupational medical diagnostics, and the internistically oriented examination, methods from a wide variety of specialist areas are added depending on the issue: Ergometry , measurement of visual acuity and other eye parameters, audiometry , spirometry , X-ray diagnostics , dermatological, allergological, neurological, orthopedic examination methods and others more.

Characteristic is the interdisciplinary orientation in the sense of communication with other, also non-medical specialties and their involvement in diagnosis and problem solving.

Medical education and training

Germany

The specialist in occupational medicine in particular knowledge, experience and skills in the prevention and early labor or -bedingter health disorders, occupational diseases and the trigger are noxious required including epidemiological principles. The core of the subject area includes health advice including vaccinations, company health promotion including individual and group-related training, advice and planning in questions of technical, organizational and personal occupational health and safety as well as accident prevention and occupational safety. Management knowledge and skills are required above all in the development of concepts for emergency medical care at the workplace (including organization and provision of first aid) and in the development of company prevention concepts ( company health management ).

The model further training regulations of the German Medical Association also lists in detail:

  • Participation in medical, professional and social rehabilitation
  • operational reintegration and deployment of chronically ill and vulnerable people in the workplace
  • Assessment of performance, resilience and operational capability including work physiology
  • Industrial and environmental hygiene including industrial medical toxicology
  • Industrial and industrial psychology including psychosocial aspects
  • Occupational medical precautionary, fitness and aptitude examinations including traffic medical issues
  • Basics of hereditary diseases including the indication for a human genetic counseling
  • Indication, appropriate sample collection and treatment for laboratory tests including biomonitoring and the occupational medical evaluation of the results
  • Medical assessment for work-related illnesses and occupational diseases, assessment of work, professional and earning capacity including questions about changing jobs
  • Occupational medical recording of environmental factors as well as their evaluation with regard to their health relevance
  • Occupational medical check-ups according to legal regulations
  • Workplace assessments and risk analyzes
  • Advice on ergonomic work design
  • Occupational medical evaluation of measurement results of various working environment factors, e.g. B. Noise, climatic factors, lighting, hazardous substances

The further training period is 60 months. Further trainers and further training centers must be authorized (i.e. approved) by the Medical Association. Of the 60 months, 24 months in internal medicine and general medicine, 36 months in occupational medicine. Up to 12 months from other areas can be counted towards occupational medicine.

As a special feature, a 360-hour course on special topics such as occupational diseases, occupational psychology, occupational physiology, ergonomics, appraisal, law, economics, technology, social insurance must be completed during the occupational medical training course. The organizers are the Academies for Occupational Medicine and Environmental Medicine in Bad Nauheim, Berlin, Bochum, Dresden, Düsseldorf, Munich and Ulm / Stuttgart.

In addition to the specialist title of occupational medicine, there is also the additional title of industrial medicine . It was a forerunner of occupational medicine and is maintained by the German Medical Association to this day, because it is assumed that there is an extremely large need for doctors working in occupational medicine, in particular for looking after countless small businesses, and that this need cannot be met at the present time by specialists in occupational medicine alone .

The additional designation of company medicine requires an already existing specialist certification in an area of ​​direct patient care. Almost every specialist can acquire this additional qualification in a one-year, full-time further education. As with specialist training, proof of participation in the 360-hour course (see above) must be provided. According to the recommendation of the 107th German Medical Association (2004), the curriculum for the additional qualification in company medicine should include 36 months of advanced training, of which 12 months are internal or general medicine and 24 months are occupational medicine. However, due to the sovereignty of the state medical associations, the requirements for further training vary depending on the federal state. In Baden-Württemberg, Bavaria, Lower Saxony, North Rhine and Schleswig-Holstein, the further training period with an authorized occupational physician is only 12 months, Westphalia-Lippe requires 18 months and in Bremen, Mecklenburg-Western Pomerania, Rhineland-Palatinate, Saarland, Saxony-Anhalt and Thuringia 24 months of training are required. In Berlin, Brandenburg, Hamburg, Hesse and Saxony, further training in the additional qualification of industrial medicine is not possible. With some medical associations, doctors with the additional designation of industrial medicine also receive a further training authorization.

Austria

In Austria, the Occupational Medicine Academy in Klosterneuburg , the Linz Academy for Occupational Medicine and Safety Technology and, since February 2013, the Vienna Academy for Occupational Medicine and Prevention (WIAP) train doctors to become occupational physicians.

The occupational medicine training builds on the medical studies and the regular or specialist training. The training goals consist in particular of recognizing health and performance-related factors influencing the physical and mental state of people in the company, evaluating the impact of these factors on the health and performance of employees, developing and implementing improvement measures and clarifying individual health disorders with regard to their possible work-related causes.

Other countries

Uniform certificates of specialist qualification are available in Europe for the following countries:

  • Belgium: médicine du travail (Wallonia) / arbeidsgeneeskunde (Flanders)
  • Denmark: samfundsmedicin / arbejdsmedicin
  • Germany: Specialist in occupational medicine
  • Finland: työterveyshuolto / företagshälsovård
  • France: médecine du travail
  • Greece, Great Britain (United Kingdom): occupational medicine
  • Ireland: occupational medicine.
  • Italy: medicine del lavoro
  • Iceland: atvinnulækningar
  • Luxembourg: médecine du travail / Aarbechts-Medezin
  • Netherlands: Arbeid en gezondheid: bedrijfsgeneeskunde / Arbeid en gezondheid: verzekeringsgeneeskunde
  • Norway: arbeidsmedisin .
  • Austria: Specialist in occupational and industrial medicine
  • Poland: medycyna pracy.
  • Portugal: medicina do trabalho
  • Sweden: yrkes- och miljömedicin
  • Spain: Medicina del Trabajo
  • Hungary: Foglalkozás-orvostan

A comparable specialist training is required for mutual recognition. This is officially regulated by Directive 2005/35 / EC, which must be mutually recognized within the EU member states. It should be mentioned here, however, that the training regulations of different EU countries differ considerably. For example, specialist training in Belgium and the Netherlands lasts four years and you do not have to have worked in a hospital - unlike in German-speaking countries. The activities are also sometimes different. A specialist in the Netherlands and Belgium, for example, does not perform ergometry , but refers the patient to a cardiologist . The Dutch occupational health practitioner also has the task of assessing the workability of employees. He also takes on a function that is reserved for the Medical Service of Health Insurance (MDK) in Germany . Furthermore, the Dutch insurance doctor (Arbeid en gezondheid: verzekeringsgeneeskunde) can call himself a specialist in occupational medicine according to the EU directive and work as an occupational doctor in other EU countries. To what extent a specialist in occupational medicine could find a job in another EU member state is doubtful, as the legal situation in particular differs in the various countries. The practical activities and training are also often quite different.

In the USA, qualifications and quality assurance in occupational and environmental medicine are carried out by the medical association American College of Occupational and Environmental Medicine (ACOEM) , as is common practice there for medical work. A detailed curriculum is mandatory for recognition by the ACOEM.

Legal meaning

The Occupational Safety and Health Act in Germany obliges every employer to ensure that their employees receive adequate occupational health care. It includes all occupational health measures required to prevent work-related health hazards.

The Ordinance on Hazardous Substances defines the term occupational health care more precisely. To her belong in particular

  • the assessment of working conditions
  • educating and advising employees
  • special occupational medical check-ups for the early detection of health disorders
  • professionally founded recommendations for work organization
  • the further development of occupational health protection through the knowledge gained

The Ordinance on Occupational Health Care (ArbMedVV) and the law on company doctors, safety engineers and other specialists for occupational safety ( Occupational Safety Act - ASiG) regulate the details . Among other things, it stipulates that only professionally qualified doctors may be commissioned by the employer to provide preventive occupational health care. The scope and tasks of occupational medical care are regulated by the accident prevention regulation DGUV V2 of the statutory accident insurance institutions .

Special preventive examinations are compulsory in the event of certain exposure, for example from hazardous substances or noise. The employers' liability insurance associations and other statutory accident insurances have issued a number of so-called investigation principles. These are in the nature of recommendations and are intended to provide pointers for preventive occupational medical examinations in line with the state of the art.

Definitions and regulations of the Hazardous Substances Ordinance are often used as an orientation in the current reorganization of other areas of occupational safety and health law.

history

In ancient Egyptian sources, such as the Ebers papyrus (1500 BC), pneumonia was reported. During the processing of the stones for the large monuments, the resulting dust was inhaled by the stonecutters and damaged their lungs.

Work-related illnesses have always been considered by the doctor in differential diagnosis. Hippocrates (460 - 377 BC) emphasized that when collecting the medical history, one should pay close attention to professional influencing factors.

The Roman writer Pliny (78 BC) gives detailed recommendations for the prevention of black lung diseases. Even in the Middle Ages, the first approaches to occupational medicine can be seen.

In Renaissance Europe , with the resurgence of scientific observation, there is an increasing interest in the connection between work and health. The doctors Paracelsus (1493–1541) and Agricola (1494–1555) examine the diseases of miners, arsenic, lead and mercury poisoning called mountain addiction. In 1700, Bernardino Ramazzini (1633–1714) published De morbis artificum diatriba, the first complete presentation of important diseases in 40 occupational groups.

Industrialization also brings with it work-related diseases, which doctors must devote to research, treatment and prevention. In 1839 the first "Occupational Safety and Health Act" was passed in Prussia . In 1884, Bismarck enforced the first accident insurance law in the new German Reich, with which the professional associations were created.

On June 13, 1906, the International Commission on Occupational Health (ICOH) was founded in Milan (in the original: Commission Internationale Permanente Pour La Medicine Du Travail).

In 1912 the Kaiser Wilhelm Institute for Occupational Physiology was founded in Berlin . After it was closed during the Second World War, it was rebuilt as the Max Planck Institute in Dortmund. In 1924, the Clinic for Occupational Diseases was established in Berlin under the direction of Ernst Wilhelm Baader . In 1933 it was expanded to become a university institute.

Little is known about the work of company doctors during the Nazi era. What is certain is that the number of company doctors in the German Reich more than eightfold between 1939 and 1944 (from 970 to 8,000), while in the same period the number of doctors who were not drafted into the Wehrmacht fell from 54,000 to 40,000, and that of doctors in public Health service from 6,200 to 5,000. It must therefore be assumed that this medical professional group was assigned a significant role in health management by the NSDAP and the Reich government . So far, however, the professional association of company doctors, the VDBW , has refused to deal with these questions. As an alternative, a purely scientific support association was founded in 2012, the support association for research into occupational medical practices during the Nazi era (FBHNS). This supports individual research projects on the topic financially.

As early as 1958, occupational hygiene was a compulsory subject in what was then the GDR, and all medical university institutions had their own chairs. Occupational health care for employees is centralized in many areas, e.g. B. in the medical service of the transport system of the GDR . In the Federal Republic of Germany (FRG) the law on company doctors, safety engineers and other specialists for occupational safety (Occupational Safety Act) came into force in 1974, and in 1996 the Occupational Safety and Health Act as a national implementation of the relevant EU requirements. After 1990 the dual system of occupational health and safety established in the FRG was also transferred to the new federal states.

Like the entire world of work today, occupational medicine is also subject to constant change. Physical stresses in the workplace decrease, psycho-mental stress increases. Environmental medicine issues have gained in importance. In place of routine examinations because limit values ​​are exceeded, there are advisory, educational and training tasks, some of which place completely new demands on the qualifications and role of the company doctor.

literature

  • E. Grandjean : Physiological work design. Guide to ergonomics. Ecomed, Landsberg 1991, ISBN 3-609-64460-5 .
  • K. Landau, G. Pressel: Medical lexicon of occupational loads and hazards. Definitions, occurrences, occupational safety. Gentner Verlag, Stuttgart 2004, ISBN 3-87247-617-3 .
  • H. Seidel, P. Bittighofer: Checklist XXL Occupational and Industrial Medicine . Georg Thieme Verlag, Stuttgart 2002, ISBN 3-13-103412-2 .
  • G. Triebig, M. Kentner, R. Schiele: Occupational medicine. Manual for theory and practice. Gentner Verlag, Stuttgart 2003, ISBN 3-87247-598-3 .
  • Markus Vieten: career planner doctor. Thieme Verlag, ISBN 3-13-116105-1 .
  • St. Letzel, D. Nowak: Handbook of occupational medicine - occupational physiology, occupational psychology, clinical occupational medicine, prevention and health promotion. Loose-leaf work. ecomed MEDIZIN, Landsberg, ISBN 978-3-609-10570-3 .
  • F. Hofmann, N. Kralj: Manual of the company medical practice. Loose-leaf work. ecomed MEDIZIN, Landsberg, ISBN 978-3-609-10230-6 .
  • Dietrich Müller: Occupational Medicine. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 90-92.

See also

Web links

swell

  1. ↑ Brigitta Danuser : Occupational medicine - insurance medicine, similarities and differences. ASIM, Basel 2006. (PDF)
  2. ^ Federal Medical Association (Ed.): Sample course book for occupational medicine / industrial medicine. 2nd Edition. May 18, 2008 ( online [PDF; 666 kB ; accessed on September 11, 2012]).
  3. ↑ Information on Belgian training in Dutch HTML ( Memento of the original from May 20, 2009 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.opl-arbeidsgeneeskunde.be
  4. ↑ http://www.knmg.nl/ Dutch Medical Association
  5. ↑ BAuA study (PDF)  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.@1@ 2Template: Toter Link / www.baua.de  
  6. ^ Harro Albrecht: sick leave. In: The time. 43, 2011.
  7. ↑ The Ordinance on the Simplification and Strengthening of Occupational Medical Care (ArbMedVV), which came into force on December 24, 2008, is an issue of preventive occupational health care .
  8. ↑ Information on regulation 2 of the German statutory accident insurance (DGUV V2) HTML  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.@1@ 2Template: Dead Link / www.mias-online.com  
  9. ↑ Volker Zimmermann: Approaches to social and occupational medicine in the medieval workplace. In: Bernd Herrmann (Ed.): Man and the environment in the Middle Ages. Stuttgart (1986) 1987, pp. 140-149.
  10. ↑ Gundolf Keil : Orality and written form. Two occupational medical recipes from Annerl Ploss from Ammersee. In: Ria Jansen-Sieben (ed.): Artes mechanicae in middeleeuws Europe. Handelingen van het colloquium van October 15, 1987. Brussels 1989 (= Archief- en bibliotheekwezen in België. Extra number 34), pp. 191–198.
  11. ↑ Winfried Süß: The "People's Body" in War, Oldenbourg Wissenschaftsverlag 2003, p. 436.
  12. ^ Association for the promotion of research into occupational medical practices during the Nazi era
  13. ^ K. Scheuch: Occupational medicine in the GDR and the association of specialist societies - summary. asu-arbeitsmedizin.com