Screening in occupational health practice

In occupational health settings, screening examinations are performed at different times and for various purposes.

Pre-placement examination

Pre-employment and pre-placement examinations are often required of persons embarking on a new job. The distinction between the terms is that pre-employment examination is usually performed before an individual is offered a job, and confirmation in the post is contingent upon passing the ‘medical examination’. In pre-placement examination, the clinical assessment is conducted after a person is offered a job based on qualifications, experience, recommendations, etc. rather than health considerations. The purpose is to determine whether there may be health reasons why an individual should not be placed in a particular workplace, and/or make any necessary workplace adjustments. The reason that is often stated for excluding an individual from a specific job is that the safety of the individual or third parties may be compromised because of the health status of the prospective employee, e.g. an infectious hepatitis B carrier proposing to perform surgical procedures.

For a proper evaluation of fitness, the examining doctor should be aware of the requirements of the job and the working environment, in addition to assessing the health status of the person. In some countries, pre-employment examinations are prohibited under disability discrimination laws. However, there may also be national regulations that stipulate pre-employment and periodic medical examination for specific occupational groups, or persons exposed to specific hazards at work, e.g. workers exposed to inorganic lead. In the UK, the Equality Act 2010 stipulates that, with few exceptions, employers should now not ask about the health of prospective employees before a job offer.

Another often stated reason for the pre-employment examination is to establish baseline health information for subsequent health surveillance. It could also be used to assess health status for medical insurance purposes, and to defend or support a subsequent compensation claim for occupational illness. It is uncertain how much use is made of such baseline information, or whether the records are readily retrievable should there be a need to refer to baseline findings from preemployment assessments.

Many occupations do not require high standards of physical fitness. The probability of discovering disease that might significantly impair job performance in apparently healthy job applicants, especially among young adults, is low. Thus, the rejection rate for fitness to work based on medical grounds is generally low. In a national audit of pre-employment assessments for healthcare workers, the rejection rate for applicants was less than 1%.14

The components of any pre-employment assessment should be justified on the basis of necessity and risk, and based on sound evidence that the specific questions asked or examinations performed are warranted for the proposed job.

If warranted, instead of subjecting every job applicant to the same general pre-employment screening, the examination should be tailored to the specific demands of the job. A self-administered health declaration or questionnaire that is processed by an occupational health adviser may be adequate for most clerical or administrative jobs. However, it has been advocated (albeit, with controversy) that more comprehensive screening be conducted for selected ‘high flier’ candidates, where substantial investment in training and resources is required. A recent evidence-based review on pre-employment examinations indicated that there was conflicting evidence on whether these procedures prevent injury, ill health or reduce sickness absence. It reaffirmed the view that, if indicated, pre-employment examinations should be job specific.15

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