Occupational Health Medicine Issues - Assignment Example

Scenario: A male client is considering pursuing legal action after his employer's announcement that the client's services would no longer be neededdue to his not being able to perform job duties as he is not able to sit for more than ten minutes at a time. This is due to the recurring lower back pain that he suffers. In order to find a comfortable position, the client must constantly be moving. He wishes to seek legal action based on the fact that his back injury occurred while on duty during basic training and continues to be aggravated by his occupational roles as vehicle driver and mechanic. In addition, this back pain has kept him from being to work for three years. Job Aspects and Implications-Low Back Symptoms, Occupational Factors, and Personal Factors: Working environment, work load, and occupational factors (such as sitting for a long period of time, and very little rest time can aggravate low back pain and recurring back pain. Little movement and physical exercise and road shock/vibration (such as when driving a vehicle for long periods of time) may cause back pain and contribute to recurring back pain. Exposures to physical and psychosocial hazards in the work environment of driving a vehicle (or in jobs where one is required to sit, or remain in a certain position, at long periods of time) can contribute to lower back pain. Such as in the client's occupation, prolonged driving is an occupation factor which should be considered. Working as a mechanic can also contribute to low back pain because it requires being in the same position (and usually with incorrect form and poor body mechanics) for quite some time. This is very similar to the demands of driving a vehicle. In addition, working as a mechanic also requires excessive bending (and remaining in a bent position) and lifting and twisting while holding a heavy object. These tasks can contribute to recurring low back pain. Add these vocational responsibilities and daily activities with the injury during basic training and one finds the perfect ingredients to recurring low back pain. Factual Background: Many people complain of low back pain. Low back pain as defined by Medline Plus Medical Encyclopedia (2007), "Pain felt in your lower back may come from the spine, muscles, nerves, or other structures in that region. It may also radiate from other areas like your mid or upper back, a hernia in the groin, or a problem in the testicles or ovaries. You may feel a variety of symptoms if you've hurt your back. You may have a tingling or burning sensation, a dull aching, or sharp pain. You also may experience weakness in your legs or feet. It won't necessarily be one event that actually causes your pain. You may have been doing many things improperly -- like standing, sitting, or lifting -- for a long time. Then suddenly, one simple movement, like reaching for something in the shower or bending from your waist, leads to the feeling of pain." The definition also includes that low back pain is normally occurs after lifting a heavy object with incorrect form (not bending the knees but bending at the waist/back, a sudden movement , or after experiencing an accident or injury. However, before one or all of these have happened, the lower back area may have already been deteriorating or leasing. Low Back Pain. A Progressive Etiology refers to Papageorgiou et al (2007), "Low back pain is a commonly occurring complaint within the general population. The background prevalence rate is often quoted as 80% or higher. However, perhaps a more realistic view of the situation would suggest that notable back trouble (i.e. that which results in care seeking or a period of disability and not just the transient twitches suffered by most) occurs with a prevalence rate of approximately 60%...Additionally, it should be pointed out that NIOSH suggested that the strongest associations were present with intense, prolonged exposures particularly when a combination of risk factors were present." Chen, Chang, Chang et al (2005) researched and wrote a study on occupational factors associated with low back pain (in urban taxi drivers) and found that "long driving time and several physical and psychosocial factors are associated with high prevalence of LBP (low back pain)... This should be further investigated in prospective studies. Future studies are needed to examine the potential adverse effects of prolonged exposure to low levels of whole-body vibration." The long-term prognosis of low back pain is that about half of the patients return to work within eight days and a very small number of individuals (2%) remain on sick leave. After a year, nearly half of the patients continue to deal with low back pain. Christensen, Nielsen, Hansen, et al (2007) reports, "Fifty per cent of the patients on sick leave returned to work within 8 days; after 1 year, only 2% remained on sick leave. At the 1-year follow-up, 45% of the patients continued to complain of LBP. LBP in general practice has a good prognosis with regard to sick leave, but a high proportion of patients continue to complain of LBP. We were not able to identify objective measures that strongly predict the prognosis of the individual LBP patient. The overall assessment by the (general practitioners) seems to be the most important predictor associated with the long-term outcome." Medical History, Treatments, and Follow Up This particular client has sought medical treatment including surgery and nothing seems to help. The patient's reported history includes the most commonly reported contributors to low back pain. These include: an accident or injury, a fall, prolonged periods of sitting or standing, operating a machine or vehicle that vibrates, and lifting or twisting while holding a heavy object. After the appropriate tests were administered it was deemed that surgery was necessary. Physical therapy was prescribed so that the client could rehabilitate and get back into his normal routine. The physical therapy involved controlling pain and inflammation, restoring joint range of motion, improvement of muscle strength and endurance and cardiovascular health. A program was developed for the client to follow at home in order to achieve overall health with the main goal of achieving adequate pain control. Extension and flexion exercises were prescribed. Focusing on tight and inflexible areas such as the hamstrings, quadriceps, and hip flexors will help aid in the relief of low back pain. With each recurring back pain incident, the client was given medicine for pain, physical therapy (if the incident created enough pain) and a program to follow for a few weeks after medical treatment. However, the client was not directed to pursue a lifetime and lifestyle of exercises, rehabilitation, rest from prolonged work (such as lifting and twisting while moving heavy objects) and sitting for a long period of time. Long-term follow up was not addressed or considered. Low back pain typically does not have a serious etiology and can be overlooked. As with most patients, the client sought medical treatment when his low back pain became unbearable, followed the treatment, "healed" rather quickly, and then fell back into the same routine that contributes to his low back pain. The return to work was not managed. There was no follow-up by any parties involved to see how the patient/client was doing. No work adjustment was suggested or made. There was no continuing support and no other individuals or agencies involved. The client simply carried on with his work and life until another low back pain situation became too unbearable and the cycle repeated itself. This is not solely the client's fault. It is not solely the employer's or doctor's responsibility. It is the responsibility of everyone-the client's, medical practitioners and therapists, family members, agencies, and employers-to insure that there is balance to keep recurring pain (regardless of the pain's location) from continuing and even from escalating. Findings and Recommendations Findings show that it is ending the client's employment is not in the best interest of the client or his employer. It is usually not in the best interest of the public. The client can and should continue working. However, adjustments need to be made in order that this client, and others, can continue employment. These changes, additions, and implementations are not only ethical but the responsibility of the company and professionals. These adjustments require the contribution of all involved. A program that clients can follow daily even after the pain has subsided, long-term follow up, physical exercise, healthier lifestyle choices, proper body mechanics while lifting, bending, etc. should be applied. Shorter work periods with breaks in between for stretches and movement should be added. In order to implement and enforce these changes, occupational health medicine should be applied. Occupational health medicine allows a program is concerned with the health and safety of workers and their families. This will involve a team of occupational health and safety professionals, which may include occupational medicine physicians, occupational and environmental health nurses, safety professionals, and industrial hygienists. Toxicologists, epidemiologists, ergonomists, and human resource professionals should be related members of this multidisciplinary team. The team's goal is to design and implement a complete health and safety program that will maintain and improve health and safety, which in turn, will increase productivity. Of course, the employer (and company) and employees and their family members will play a large role. Also, the program should be evaluated and changes and additions should be made accordingly as feedback and results are gained during implementation. The program should begin with a knowledgeable and professional company that provides a safety work environment for its employees. This means that management should be properly trained and should train their staff properly. Companies are realizing more and more that their number one asset is people. Although products, raw materials, services, etc. contribute to the success of a business, a business's staff is its top resource. Even if a company refuses to acknowledge this very fact and invest in its employees, the results will be evident. Lack of knowledge, an unsafe work environment, poor skills, less quality of work, mismatched jobs, difficulty in performing job tasks, and minimal customer results are just a few of the consequences of not investing in the staff. Companies now realize that they should not only invest in their clients/customers but also in their employees. The Faculty of Occupational Medicine of the Royal College of Physicians (http://www.facoccmed.ac.uk/index.jsp) provides extensive information and education on this very topic. Doctors should advise patients on their suitability for work (job fit) as returning back to work from an injury and/or a medical procedure may be too strenuous. Doctors should inform patients of their particular disorder and how their job duties can contribute to their health issues, or medical conditions. The Faculty of Occupational Medicine has publications that offer guidelines to companies and employers who wish to work with their employees who deal with chronic fatigue syndrome. Long-term sickness absences can be reduced by following certain guidelines and taking certain measures. Alcohol and drug abuse is another area that occupational health medicine professionals can assist. Guidelines provide an ethical way in implementing these programs. Evidence-based guidelines can also assist companies in preventing, reducing, and managing low back pain that employees deal with as "(disability) from back pain in people of working age is one of the most dramatic failures of health care in recent years. Its greatest impact is on the lives of those affected and their families. However, it also has a major effect on industry through absenteeism and avoidable costs (the CBI estimate that back pain costs 208 for every employee each year) and at any one time 430,000 people in UK are receiving various social security benefits primarily for back pain", as reported by Waddell and Burton (2000). In conclusion, releasing the client from employment is not in the best interest of anyone. The company must take a look at the bigger picture. Implementing occupational health medicine by using evidence-based guidelines is a better approach as this will produce a win-win situation for both companies (employers) and employees. References Chen, J.; Chang, W.; Chang, W. et al (2005). Occupational Medicine. Occupational factors associated with low back pain in urban taxi drivers. Occupational Medicine 2005 55(7):535-540; doi:10.1093/occmed/kqi125. Medline Plus Medical Encyclopedia (2007). Retrieved 06 November 2007 from http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm. Low Back Pain. A Progressive Etiology (2007). Papageorgiou et al. Estimating the prevalence of low back pain in the general population: Evidence from the South Manchester Back Pain Survey. Spine 20: 1889-1894. Retrieved 06 November 2007 from http://www.wcb.ab.ca/providers/medref08.asp Schittz-Christensen, B.; Nielsen, G.; Hansen, V.; et al (2007). Long-term prognosis of acute low back pain in patients seen in general practice: a 1-year prospective follow-up study. Family Practice Vol. 16, No. 3, 223-232 Oxford University Press 1999. Waddell, G. and Burton, K. (2000). Occupational Health Guidelines for the Management of Low Back Pain: Evidence Review and Recommendations. Retrieved 09 November 2007 from http://www.facoccmed.ac.uk/pubspol/pubs.jsp Read More