Evidence base for pre-employment medical screening

Abstract

This paper examines the evidence base for the use of pre-employment/pre-placement medical examinations. The use of pre-employment examinations is often driven more by cultural practices than evidence. There is a lack of evidence on their effectiveness in preventing health-related occupational risks. Hypertension screening is highlighted as a common pre-employment practice for which there is no standardized criteria to use to determine fitness for work. There are inherent problems in screening for psychiatric disorders and substance abuse as well as potential for racial bias and other unintended negative effects. This paper questions the economic case for this practice and also expresses concerns about paternalism related to identified risk factors. Health assessments should only be included when appropriate to the task environment and the general use of pre-employment exams and drug screening should be eliminated. Generally, a health assessment by questionnaire should suffice. Occupational health providers should advise against the application of physical or mental standards that are not relevant to fulfilment of the essential job functions. Consensus development regarding best practice, as well as consideration for acquiring outcome data related to pre-employment practice, is recommended.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬

Postoffer Pre-Placement Screening for Carpal Tunnel Syndrome in Newly Hired Manufacturing Workers

“…31 As a profession, there is a need for occupational health professionals to re-examine current practices in light of existing evidence, and to seek additional evidence on the utility – or lack of utility – of commonly performed screening that may determine future employment. 31, 32 …”

Occupational Health Practice and Exposure to Nanoparticles: Reconciling Scientific Evidence, Ethical Aspects, and Legal Requirements

“…14 So far, OHP behavior should reconcile several uncertainties and the required need for action. Although the practice of medical examinations is often based more on sociocultural drivers than on evidence, 22 the OHP must carefully explore the ethical issues in relationship with the different stakeholders. In particular, the OHP should consider what is the minimum level of evidence required to make a decision according to the principles of beneficence, autonomy, and justice.…”

Do workers’ health surveillance examinations fulfill their occupational preventive objective? Analysis of the medical practice of occupational physicians in Catalonia

“…Although the code of ethics of the International Commission of Occupational Health states in its basic principles that "occupational health professionals are experts who must enjoy full professional independence in the execution of their functions" [17], it cannot be guaranteed that this is always the case [18]. The high number of health examinations performed (4 million annually in Spain), most of them including blood and urine tests despite their acknowledged low job-specificity, could be explained by a badly understood concept of "health surveillance," by cultural and historical factors [19] (on occasions understood by workers and their representatives as "acquired rights," and by employers as something "tangible" in return for their economic investment on health surveillance or as a means of, supposedly, formally complying with their legal requirements), and by economic interests by the OHS themselves. At an approximate cost of 50-60 euro per health examination [20], direct costs to Spanish companies would amount to the minimum of 200 million euro per year, and thousands of millions of euro if extrapolated to Europe.…”