September 30, 2002
 
What To Expect During An Occupational Health Exam
 
Peter Greaney , MD
Board-Certified Occupational Physician
President, WorkCare

Every year, hundreds of thousands of public and private employees are required to take occupational health exams.  Understanding the components of an occupational physical exam will allow you to have a good understanding of what to expect, easing any possible anxiety about the process.   This article provides general information on common physical tests conducted during the exam process, and clarifies expectations about these testing procedures.

Employees may be required to take occupational physical exams for one or more of the following reasons:

Preassignment (pre-placement)

Some companies require pre-placement testing as a means to determine if the applicant has the capacities to accomplish the specific duties of the job, based upon the physical, environmental and psychological demands of the position.

Compliance

Physical exams may also be required by federal agencies, such as the Department of Transportation, Federal Aviation Administration and U.S. Coast Guard.  These agencies often require these exams as part of a pre-placement process.  The tests are also used to maintain professional licensure for existing governmental employees.  The focus of these exams is to avoid potential work-related accidents by detecting medical conditions that may result in a loss of consciousness, affect a person's ability to see, hear or operate heavy equipment. 

Periodic medical surveillance

Medical surveillance is the periodic testing of employees exposed to potentially hazardous materials or other risks in the workplace.  The purpose of medical surveillance is to detect early signs of work-related illness so that appropriate action can be taken to eliminate the underlying exposures.  OSHA requires companies to conduct medical surveillance when workplace exposures to carcinogens or chemical substances fall within the OSHA action level.  For instance, OSHA often requires medical surveillance to detect illnesses caused by materials such as asbestos, lead, formaldehyde, benzene, and hazardous waste.  The American College of Occupational and Environmental Medicine, an organization of physicians who champion the health and safety of workers state:  "M edical surveillance is a valuable tool for assuring and maintaining a healthful workplace environment."

Post-illness or injury (return-to-work)- An employee's health status may be reevaluated following prolonged absence from work due to illness or injury. This exam is conducted to ensure that an employee has sufficiently recovered from an illness or injury to perform the job without harm to himself/herself or to others.

Components of Tests

Physical testing is composed of several distinct tests.  Exam components may vary based upon the protocols required by your company.  In general, an occupational health test may include:

• Physical exam
• Vision
• Audio Tests
• Pulmonary Function (PFT)
• EKG
• Blood Draws
• Chest x-ray

The following information describes what to expect from some of these procedures. 

Physical Exam- The physical exam is conducted by an occupational health physician, a physician assistant, or nurse practitioner and is designed to provide an assessment of your health as it relates to your specific occupation.  The evaluation usually consists of a thorough physical exam:  review of systems (head/neck, heart/lungs, gastrointestinal, genitourinary, skin and soft tissue, musculoskeletal, neurological).  A physician will usually inquire further on any positive responses on your medical history questionnaire to help determine your physical ability to work. 

Vision Screening- This test screens for visual acuity (both near and far visual fields, depth perception) or color (if required on job).  A glaucoma screen may also be performed under certain circumstances.  The exam may be performed using a standard eye chart or with a Titmus Vision Screener.

Audiometric Tests- This testing is part of OSHA's hearing conservation program, which is designed to protect workers with significant occupational noise exposure from suffering material hearing impairment.  A common misperception about the hearing test is that it should performed in a sound proof booth.  According to OSHA, a soundproof booth is not required. Rather, rooms used for audiometric testing shall not have background sound pressure levels exceeding those as specified in OSHA's occupational noise standard.  http://www.osha-slc.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9739

Pulmonary Function Test-- Pulmonary function testing (PFT), or lung function testing, is a method of determining how well your lungs and airways are working. The most common PFT is called spirometry . This test requires that you take in as deep a breath as possible, blowing out all of the air as fast and as hard as you can.  Three attempts are needed, and the best effort is recorded.  Your technician should provide verbal coaching to ensure you have performed to the best of your ability.

EKG-- An Electrocardiogram, commonly referred to as an EKG, is a recording of the electrical activity of the heart. Electrodes are placed on your arms, legs and chest to record a series of heartbeats that will help determine your diagnosis. It is completely painless.

Blood Draw- Although this procedure likely causes more anxiety than most other tests performed during the physical exam process, venipuncture is quick, easy, and relatively painless.  In some situations, a blood draw may require three attempts-this is acceptable and there is no reason for alarm.  However, you have the right to request additional medical personal to oversee or conduct the procedure if the phlebotomist has difficulty drawing blood upon the second or third attempt.

Chest X-ray --The chest x-ray is the most commonly performed radiographic exam. Approximately 45% of all radiographic exams are chest x-rays. A chest x-ray is usually done for the evaluation of lungs, heart and surrounding anatomy. Pneumonia, heart failure, pleurisy and lung cancer can be diagnosed or suspected on a chest x-ray , along with other less common conditions.

Summary

Although the occupational health exam may not be as comfortable as a visit with your personal physician, it's a necessary job requirement that protects the health and safety of you and your fellow employees.  Knowing what to expect-and not expect-will avoid any surprises, making it a less stressful experience.