THE PREPLACEMENT EVALUATION

The preplacement evaluation remains one of the most common examinations in occupational medicine practice but is still often misunderstood and poorly performed. It is likely to be conducted by a primary care physician rather than a board-certified occupational specialist. There has been a trend in recent years of preplacement physical assessments being increasingly done by nonphysician providers, including physician assistants and nurse clinicians. The lack of occupational medicine training among primary care physicians performing preplacement evaluations can result in various medical, ethical, and legal dilemmas. 22 Family physicians may experience considerable anxiety caused by a sense of divided loyalty to the employer and the patient-employee. 29 Some authors have even contended that primary care physicians performing employment-related examinations often compromise principles of medical ethics, such as confidentiality, truth telling, and beneficence. 21,35 The preplacement evaluation may be requested by a private employer or mandated by a government entity, such as the Occupational Safety and Health Administration (OSHA), the Department of Transportation (DOT), or the Federal Aviation Administration (FAA). Consequently, the content of these evaluations varies considerably. The most common format consists of a self-administered health questionnaire (often outdated), a cursory physical examination, and a few laboratory studies (e.g., urine drug screen). Critical information regarding essential job tasks and workplace exposures is often not available to the examining physician. These so-called form exams leave much to be desired.