The new why when designing mandatory medical examinations

The basic medical training of physicians is almost completely carried out in hospitals using a traditional medical model and this may be less relevant for future preventive work in public or occupational medicine. This is especially the case when performing mandatory medical examinations on workers where the traditional approach hampers good practice. The ‘why’, when thinking about mandatory medical examinations in workers, could be described as to periodically verify, given some specific and special working conditions, whether an employee can perform his or her job safely without an increased health risk [1]. National laws, regulations and professional practice guidelines are responsible for differences between countries in how occupational medicine professionals deal with the content (‘the what’) and procedures (‘the how’) around mandatory medical examinations of workers. The different terminology that is used seems to be the least of the problems: pre-placement health assessments, pre-employment medicals, on-employment medical examinations, fit-to-work medical assessments, etc., because they all speak more or less for themselves. Sectoral differences are obvious because for jobs in some sectors the boundaries between countries are less-existent and therefore applying the same criteria seems logical when a worker crosses countries on a daily basis (i.e. seafarers, train drivers, pilots, professional divers or jobs in the off-shore industry). For these jobs, international consensus guidelines among medical professionals on the content of mandatory examinations have been around for decades. Unfortunately, the classical clinical way of thinking (looking for symptoms, signs and diseases) was predominantly used when designing ‘the what’ in these medical examinations: long lists of diseases had to be checked off by the physician and questions about health history were normal. Today, it is more difficult to update and improve the content of these medical examinations when the old medical protocols continue to be taken as a starting point when updates are discussed, resulting in only small amendments and without questioning their basis. A new basis is needed, the ‘new why’, when designing and performing mandatory medical examinations on workers.

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