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Competency 2 – Good Clinical Care: to understand and manage the legal and ethical implications of advice on suitability for work

Objective: to understand and manage the legal and ethical implications of advice on suitability for work

KNOWLEDGE:

Understand that advice and treatment of common conditions may impact on fitness for work.

There are many people taking medication who are in work. Some people require regular medication for chronic disease (e.g. diabetes or asthma). Some people require treatment for acute ill health but are still able to remain in work e.g. antibiotics for a urinary tract infection or chest infection.

It is important to consider the impact of common health conditions on individuals in relation to their occupation. This can be divided into:

Impact of health condition on performance:

On the whole, people are able to work with simple self limiting medical conditions and with some chronic diseases such as epilepsy and diabetes.

However there are examples of occupations where a certain level of fitness is mandatory.

Consider an individual who is complaining of nasal and sinus congestion. Most occupations would not deem these sufficient grounds for not working. However if your job involved diving or flying then you would be declared unfit to work until the symptoms had resolved.

Impact of health condition on safety of individual and others.

Common conditions such as epilepsy need careful review. A recently diagnosed epileptic would be considered unfit to drive, operate machinery, work at heights, or night work but could work safely in an office or call centre.

Adverse effect of work on health condition.

Some conditions are worsened by an individual’s job and make it difficult to advocate fitness for that particular job. For example, a hair dresser with contact dermatitis could be considered unfit to continue their work, as the continued exposure to water and chemical agents aggravates the skin condition leading to chronic dermatitis which is difficult to manage and may not resolve even if work is discontinued. In contrast a history teacher with the same condition due to exposure to glues fused for hobbies, would be fit to continue teaching as the condition is not aggravated by their work.

Effect of Medication

Medication can result in unwanted effects that may or may not be predictable.
Of particular concern are the effects on certain medications on performance, such as operating machinery, driving vehicles or flying aircraft. Some drugs may produce problems for patients in particular situations. For example, it is advisable that fire fighters are not prescribed beta blockers as this may suppress their reaction time which can be of crucial importance in situations of stress.

Fitness Standards
There are certain occupations in which a level of fitness is essential. Below are some examples:

  • Pilots, flight engineers and traffic control officers need to satisfy a particular medical standard. This takes into account the demands of their job and the risks associated with their own safety and the safety of the public.
  • Pilots for instance require good cardiovascular function due to the possible exposure to harsh environments such as hypoxia, and sudden changes of pressure and temperature. Pilots are screened for conditions that might be aggravated by sudden changes in pressure such as middle ear and sinus disorders. The Civil Aviation Authority provides detailed guidelines regarding fitness for work in the different job profiles for the aviation industry.
  • Fire fighters must be able to operate in very diverse environments. They must be able to cope with extremes of temperature, work under stressful situations and perform physically arduous tasks on regular basis. They have to be able to wear breathing apparatus and specialised equipment whilst working. 
  • Drivers. There are set medical standards required for safe driving which include standards for the driving of lorries and buses. 
  • Divers. Employed divers are covered by the Diving Operations at Work Regulation 1997 which details the requirements of individuals working in this service. The regulations cover those involved in the oil and gas industries in the North Sea as well as those using scuba instruments.

Understand the concepts of hazard and risk and of occupational and environmental risk assessment and management.

Hazard is defined as ‘something with the potential to cause harm’, and this can be divided into

  • Chemical
  • Physical
  • Mechanical and ergonomic
  • Biological
  • Psycho-social/organisational

Risk can be defined as the likelihood of harm occurring in defined circumstances.

When assessing an individual’s fitness to work it is important to explore the following:

  1. A basic knowledge of the job demands and working environment before undertaking any assessment.
  2. Any medical conditions that could pose a risk to the individual’s or others health and safety or that could affect their attendance or performance.

In straightforward cases a medical assessment along with the doctor’s existing knowledge of the job demands and working environment may be sufficient for a recommendation of fitness. However, a closer look at occupational factors is often needed to complete a full risk assessment.

Factors to be considered include:

The precise requirements of the job

  • Perception, mobility, strength endurance
  • Obtain job description from employer as well as asking the employee what the job entails.
  • Inspecting the worksite.

The individual’s abilities in the working environment

  • Reviewing physical condition on actual performance.
  • Reviewing mental condition on actual performance.
  • Considering trial of employment with feedback from all involved.

The nature of any hazards (risk of harm occurring)

  • Harm from exposure in the workplace: asthma (bakers, laboratory technicians), dermatitis (hairdressers, builders)
  • Harm from demands of the job: heart attack (situations where there is an imbalance between demands of a job and a person’s ability to cope), back strain (static movements, repetitive twisting, bending).
  • Harm from infections: food handling (salmonella, campylobacter), surgical procedures (blood borne viruses).
  • Harm from situations: accidents (slips and trips)

The probability of harm occurring (the actual risk in the workplace)

  • Permanent or temporary
  • Major or minor

Who is at risk

  • Employee
  • Work colleagues
  • Public

Degree of risk: rely on facts available by means of

  • Obtaining relevant details from employee
  • Reviewing documentation: accident reports, exposure records.
  • Walk through; observing working practices.
  • Identifying frequency and duration of hazard exposure.
  • Technical data if available: reports from hygienist or ergonomists (competency 6).
  • Research; checking sources of information. 
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