Pre-employment examinations & Pre-employment examinations & fitness standardsfitness standards
Professor T.C. AwMBBS, PhD, FRCP, FRCPC, FFOM, FFPHM
Head, Division of Occupational Health
University of Kent
Pre-employment examinationsPre-employment examinations
Purpose:• Detect clinical abnormalities that indicate a
mismatch between state of health and proposed job
• Enable necessary adjustments to be made
Pre-employment examinationsPre-employment examinations
Implications
Risk of ill-health or injury to– Individual– Co-workers– Customers– Patients– Visitors
Pre-employment examinationsPre-employment examinations
Employer ‘reasons’ Shows a caring employer Reduces costs to organisation
– Sickness absence– Staff time– Hospital bills
Establishes health status before starting Inform individuals of hazards & prevention Fit man to job
Pre-employment examinationsPre-employment examinations
Employee ‘reasons’Inform individual of hazards & preventative
measuresEstablishes health status before starting workAdjustments to job to fit the manHealth status at the time
Pre-employment examinationsPre-employment examinations
Occupational health ‘reasons’Assess the match between person & jobObtain baseline informationCheck on immunisation status & updateOpportunity for health promotion & adviceAllows effective follow up for clinical conditions
detected – continuity of care
Pre-employment examinationsPre-employment examinations
Practical reasons:Employer requirementGovernment requirementEvidence-based reason
Pre-employment assessments in Pre-employment assessments in the NHSthe NHS
Whitaker S, Aw T-C
Occupational Medicine 1995;45(2):75-80
Braddick MR, Atwell CP, Aw T-C
Occupational Medicine 1992;42:36-38
Pre-employment assessmentsPre-employment assessments
30% random sample of 217 occupational health units40 participating units 3-month period
Pre-employment assessmentsPre-employment assessments
Methods used:Self-administered questionnaire 4517Quest. + nurse interview 3116Quest. +/- nurse interview 688Quest. + nurse interview +/- Dr. exam 390Quest. + nurse interview + Dr. exam 196Nurse-administered Quest. 41
Pre-employment assessmentsPre-employment assessments
Decision: Nos. %Fit 8954 98Restriction 120 1.3Rejection 65 0.7
Total9139
Findings:Findings:
What were the main reasons for Rejection & Restriction?
Pre-employment assessmentsPre-employment assessments
Reasons for rejection: BMI (Kg/m2) 26 40% Skin conditions 14 21.5% Psychiatric conditions 7 10.8% Musculo-skeletal conditions 4 6.2% Raised BP 2 3.1% Others 12 18.5%
TOTAL 65
Findings:Findings:
Which staff groups had the highest rejection/restriction?
Pre-employment assessmentPre-employment assessment
Rejection by occupational group: Technician 3/88 3.4% Student nurse 17/1000 1.7% Catering staff 4/235 1.7% Nursing assts. 14/949 1.5% Qualified nurse 7/2159 0.3% Administrative staff 1/422 0.2% Doctor 1/1127 0.1%
Pre-employment examinationsPre-employment examinations
217 questionnaires
Pre-employment examinationsPre-employment examinations
Question:
Necessity or unwarranted?
Is it necessary? Is it necessary? YESYESEnsure man is fit to do the jobAdjustments of job to fit the manCost-effectiveness depends on the consequences of
the abnormality detected– Munchausen by proxy (Allitt)– Hepatitis B carriers– Shipman
Is it necessary? Is it necessary? NONO
Low pick-up rate Poor predictor of state of health Costs Logistics Disability Discrimination
‘‘ShipmanShipman’’
Pre-employment examinationsPre-employment examinations
OPTIONS:
1. Scrap them altogether
2. Retain in limited &/or modified form
3. Carry on as at present
Pre-employment examinationsPre-employment examinations
Practical considerations:Limit pre-employment assessment to ‘high-risk
groups’Agree standard questionnaire for specific
occupational groupsQuestionnaire for all, examination and tests for
someComputer-administered or computer scanned
questionnaire
Pre-employment examinationsPre-employment examinations
CRITERIA: Jobs requiring PEE Job has implications for 3rd parties Recognised uncontrollable hazards of the job
– PHYSICAL: noise– CHEMICAL: asthmagens– MECHANICAL: manual handling– BIOLOGICAL: body fluids – PSYCHO-SOCIAL: stress
Liability for employer?
Pre-employment examinationsPre-employment examinations
Questionnaire– Self-administered– Nurse-administered
Examination– Nurse– Physician (GP)– Occupational physician
Investigations– X-rays, blood tests, urinalysis, etc
Pre-employment examinations & Pre-employment examinations & Fitness standardsFitness standards
PROCESSEstablish Fitness standardsQUESTIONNAIRE + staged referral
Nurse interview + assessment +/-medical examination
Consideration: Cost-effectiveness?
Fitness standardsFitness standards
Job categoriesPilotsDrivers (Public service vehicles & heavy goods
vehicles)Food-handlersSea-farersUniformed services (police, army, fire-fighters,
ambulance crew)
Medical standards for fitness - Medical standards for fitness - DriversDrivers
Vision (new drivers) should be 6/9 on the Snellen scale in the better eye and 6/12 on the Snellen scale in the other eye (wearing glasses or contact lenses if needed) and 3/60 in each eye without glasses or contact lenses.
Medical standards for fitness - Medical standards for fitness - DriversDrivers
DIABETES All on oral hypoglycaemics or insulin must inform DVLA (in
general, stop driving for 1 month after starting insulin, to get stable;
drivers must demonstrate satisfactory control, and must recognize hypoglycaemia).
Check that vision conforms to required standard. Advise avoid driving if hypoglycaemic risk á (eg meal delay; or
after excess exercise).
Medical standards for fitness - Medical standards for fitness - DriversDrivers
EPILEPSY A person who has an epileptic attack whilst awake must not drive
for one year from the date of the attack. A person who has an attack whilst asleep must also refrain from
driving for one year from the date of the attack, unless they have had an attack whilst asleep more than three years ago and have not had any awake attacks since that asleep attack.
In any event, they should not drive if they are likely to cause danger to the public or themselves.
Medical standards for fitnessMedical standards for fitness
TRANSIENT ISCHAEMIC ATTACKSPatients with TIA or stroke should not drive for at least
one month. If TIAs have been recurrent and frequent, a 3 month
period free of attacks may be required.Patients who have had a single episode of loss of
consciousness (no cause found) still need to have at least one year off driving.
ReferencesReferences
DVLA (2006). At-a-glance guide to the medical standards for fitness to drive. DVLA, Swansea [www.patient.co.uk/showdoc/40000803/]
Palmer K, Cox R, Brown I. eds. (2006)Fitness for work – the medical aspects 4th edition. Oxford University press, Oxford.
Pre-employment Pre-employment QUESTIONNAIRESQUESTIONNAIRES
Limit number of questions:Retain useful questions – reasonRemove ‘not useful’ questions
– Varicose veins, piles– Dysmenorrhoea vs. periodic pain
Details of proposed jobDetails of proposed job
No informationJob titleJob title, department and location of postJob specificationImmediate supervisorOHD walk-through
OTHER DATA:OTHER DATA:
Reports on previous health Reports on present treatmentRecords of sickness absence
Decision & adviceDecision & advice Fit / suitable Fit with restriction, e.g.
– Review as patient is under treatment– Shift work– Work at heights– Moving machinery– Driving– Lifting
Unfit / unsuitable
QuestionQuestion
What should you advise if: A blind person wants to fly a plane A diabetic wants to row across the Atlantic An amputee wants to climb Mt Everest
ConclusionsConclusions
Pre-employment assessments:Focused / selected groupsUniformity in methodAgreed criteria / fitness standardsBased on job requirementsPeriodic audit
Occupational Health [at Work] Occupational Health [at Work] 2006;3(3):18-252006;3(3):18-25
Ballard J (2006)
‘Pre-employment health screening: Part 1 – pre-employment questionnaires’
