Guidance for Occupational Health Services in Medical Centers

Guidance for Occupational Health Services (OHS) in Medical Centers is dedicated to the memory of Dr. Geoff Kelafant, who was tragically killed in a diving accident in March 2004. Geoff was the original author of a set of guidelines for the practice of occupational health in medical centers and developed the idea to establish a public access internet site to assist practitioners of medical center occupational health (MCOH). For over 10 years, he developed and maintained the guidance document, added a broad range of additional information and links, and summarized information essential to the care of medical center-based working populations. Geoff did nearly all of this work without financial support and was steadfastly dedicated to improving the quality of medical practice in our field. In addition, he established an on-line discussion forum to address MCOH practice issues. Geoff oversaw the forum with his own unique and wonderful combination of biting wit, good judgment, and pithy commentary. Geoff was a dear friend and respected colleague. He was bright, funny, kind, and brutally honest. His gifts to those who practice MCOH have been inestimable; his absence leaves a void in our professional lives and for a great many of us, in our personal lives as well. Few have contributed as much to our small field. Geoff’s enduring legacy is the profound impact he made on MCOH in the United States and Canada. His work supported the creation of a real community, a common purpose, and a set of standards among those of us who practice in the field. In many cultures and belief systems, we live on in this world because of our good deeds; Geoff will live longer than most. Purpose of This Guidance Document This document represents a collation of pertinent guidance, best practices, and professional opinions applicable to the practice of occupational medicine in the medical center setting. Its intent is to provide assistance in handling the broad range of issues encountered by hospital-based occupational medicine practitioners. The guidance document and its hyperlinks will be updated periodically to incorporate new information as it becomes available. Role of the MCOH Provider Medical Assessment of Employees Occupational health practice in a medical center setting requires the same skills as such practice elsewhere, including thoughtful administrative management; knowledge of and interactions with safety, industrial hygiene, and toxicology; and sound preventive and clinical medicine, including surveillance, assessment of history and physical findings, diagnosis, treatment, and disposition. Preplacement Medical Evaluation (PPME) The PPME usually represents the first clinical encounter for a prospective employee, setting the tone and defining expectations from OHS. The PPME, which must be done after the offer of a job, serves to document those existing medical issues that are likely to have an impact on the new employee’s performance, health, and safety in the health care work setting. It is not designed to diagnose or treat previously undiscovered medical problems. The Americans with Disabilities Act of 1992 requires job descriptions that identify the “essential functions” of the job to be offered, with specific, precise descriptions and terminology with which employee capabilities must be compared. 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