PRINCIPLES OF TOXICOLOGY

506 OCCUPATIONAL AND ENVIRONMENTAL HEALTH
The patient was restricted from any further exposure to the paint packaging department or other areas
where exposure to isocyanates might occur and his symptoms improved.
Training and Education
Another critical function of occupational health professionals is training. They are responsible for
communicating with management, government, and workers about the hazards of workplace exposure,
and about proper remedial actions. According to OSHA’s Hazard Communication Standard, workers
have a “right to know” about chemicals to which they are exposed, through information sheets
(Material Safety Data Sheets), labels on chemical containers, and training programs. Important
information includes the identity of chemicals, their acute and chronic health effects, how to respond
to emergency situations, and how to prevent toxicity. Not only workers, but also supervisors and
managers must be thoroughly familiar with chemical hazards. Available changes rapidly as more
research results are reported, so keeping abreast of new developments is essential. Increasingly,
occupational health professionals must not only recognize and control hazards, but also communicate
this information to those they serve.
Setting of Occupational Medicine Service Delivery
Occupational medicine services are delivered in a variety of settings. Over time, with changes in
business practices and the health care system, these settings have evolved.
In the past, the prototype setting for occupational medicine service delivery was the workplace
itself, usually in a medium- to large-sized manufacturing facility. Plant physicians and nurses, based
in dispensaries close to the work process, would look after workers with injuries, conduct preplacement
and return-to-work physical examinations, and in some cases evaluate injury and illness trends in the
workforce and initiate prevention programs. Some industries still maintain on-site physicians and
nurses, especially in very large and/or remote plants. The physicians may be community practitioners
who spend only part of their time at the plant. But increasingly, this work is being “outsourced” to
private practices outside the plant.
The private practice of occupational medicine is growing rapidly. Occupational medicine practices
may be based at community hospitals, multispecialty group practices, managed care organizations
such as health maintenance organizations (HMOs), or freestanding specialty practices. Typically an
occupational medicine practice will serve dozens or even hundreds of client companies, treating acute
injuries, conducting routine examinations, and providing other services, including unnecessary ones,
to client companies. Critics argue that company physicians and nurses become thoroughly familiar
with their companies’ facilities, enabling them to provide in-depth expertise that multiclient practices
cannot match. On the other hand, multiclient occupational medicine practices offer important advantages.
Providers in multiclient practices can amass broad, diverse experience in program development,
data management and analysis, regulatory compliance, and other occupational health activities, which
can, in turn, enable them to deliver a high level of service. Providers in multiclient practices can remain
independent of individual employers, which may help avoid some ethical dilemmas (see discussion
below). Small and medium-sized firms, which are unable to afford in-house occupational medicine
services, can better afford the services of multiclient practices. Even larger firms often find it more
economical to outsource their occupational medicine. Finally, occupational health providers in
managed care organizations can potentially integrate their services with primary medical care, leading
to more continuous, less fragmented care.
A third setting for occupational medicine service delivery is the academic setting. Many major
medical centers, with links to medical schools and/or schools of public health, now have occupational
medicine units. These may be located in departments of medicine, family practice, or preventive
medicine. Academic occupational medicine units provide many of the clinical services noted above.
However, they differ in important ways from community-based practices. Typically their staffs are
highly trained, with board certification in several medical specialties including occupational medicine.