Clinical tasks

Besides your education, what other work have you done?

List the following in columns:

1. The hazardous agents or circumstances that were potentially relevant to health
2. The nature of the respective health risks, their likelihood and severity
3. The steps taken to inform about and to prevent those risks

Pause and consider if you were a qualified physician, whether you would recognise those health risks and how you would react to them - in particular, what advice would you give about prevention?

You may wish to consult some guidance regarding the influence of Work on Health (agius.com website)

Next time you are in a ward find out the answers to the following:

• What jobs do the staff do?
• To what specific physical, chemical or biological agents or psychological stresses might they be exposed?
• What risks to their health might these exposures entail?
• Do you and they have the information you ought to have about the hazards?
• What steps should be taken to reduce the risks?
• Are they being implemented adequately?
• If not, what can be done?

When you are next in a general practice (as an attachment as part of your training, or even as part of your responsibilities) and have time with one of the GP principals, discuss the following:

• The hazards relevant to the staff in the practice
• The assessment of the risks to their health from their work
• The steps taken to reduce these risks

Ask to see a copy of one of the assessments that the manager is required to keep by law such as under the Management of Health and Safety at Work or the Control of Substances Hazardous to Health Regulations and discuss it with the GP.

• Do you consider the assessment to be suitable and sufficient?
• What lessons have you learnt from this exercise?

Do not restrict your discussion and conclusions to the limited (but very important) context of the Health and Safety of employees in primary care, but attempt to extrapolate to other occupations.

You may wish to consult some guidance regarding the Management of Health and Safety in Workplaces (agius.com website)

Consider a specific adult patient you have seen in general medical practice or in hospital, and who is suffering from a disease such as asthma, dermatitis, or back pain. Take a careful occupational history as well as a history of other relevant exposures: DIY, leisure, etc.

Is it possible that some of these exposures could be contributing to the ill-health by causing it, or by aggravating it?

If this is a possibility, consider the answers to the following questions:

• To what hazards is the patient exposed?
  You may wish to consult some guidance regarding the influence of Work on Health (agius.com website)
• How can you determine the extent of exposure to the hazards?
• Therefore what is the patient’s ‘a priori’ risk of work-related ill-health?
• How may the patient’s symptoms and signs relate to the occupational risks in terms of … timing? … severity? … biological plausibility? … consistency with other observations? (Remember the epidemiologic criteria for causal association and consider the clinical analogies).
• What steps would you consider to protect the patient, by reducing exposure … at source? or … through personal protection? … or in other ways?
• Who would you liase with, to achieve these aims?
• What about the risks to other workers: How would one determine the frequency of similar ill-health amongst fellow workers? … How would one find out who was at risk? … What steps should be taken to protect them?

Consider a specific patient that you have seen in general medical practice or in hospital (for example, after an operation or recovering from a myocardial infarct). Is he/she fit to perform his/her job effectively and safely?

What can be done to rehabilitate the patient back to work?

Take a careful history and consider changes in tasks, facilities, hours worked or other means of occupational rehabilitation.

You may wish to consult some guidance regarding Rehabilitation and employment of the disabled (agius.com website)

Consider what combination of potential health problems and work practices relevant to you as a health care worker could pose a health and safety risk to yourself and/or to others. What steps should you take, and should your employer take steps to reduce these risks?

Remember that even if you are not yet an employer, in due course you will probably have the responsibilities of an employer. In any case even now you are almost certainly owed and have some responsibilities as an 'employee'. Therefore it is important that you should appreciate the duties and responsibilities of both these perspectives now.