1.0 PURPOSES OF WORKER EXAMINATION
Some industries require medical examination for fitness to
perform. Examples are food handlers examined for infectious disease, soldiers or airline pilots examined for fitness. Even if such examination is part of the job contract, the examining physician should
seek consent of the worker. It is also illegal to test specimens of body fluids that are obtained without consent for example
sweeping an article touched by a worker for a specimen to DNA testing.
2.0 DISCLOSURE OF MEDICAL FINDINGS TO THE MANAGEMENT
This becomes very complicated when it comes to issues of disclosure
of medical findings. The employer would like to have the information whereas the employee may refuse to give the necessary
consent. Medical information custody is with the physician and cannot be disclosed to the employer without employee consent
unless such disclosure is provided for in the employment contract. To avoid any confusion the physician should make sure that
the employee still sticks with the consent in the contract. If the employee has changed his mind the examination cannot proceed.
The results of the examination should be disclosed to the worker first and he has the right to decide on further disclosure
to the employee. If the worker refuses disclosure the physician reports the matter and the employer may decide on termination
based on breach of contract.
3.0 SICK LEAVE
The physician may find himself in a conflict situation when
he wants to grant sick leave but the employer does not want because of economic loss. In general this matter can be resolved
by the assumption that leave is granted by the employer; the physician’s job is to make a professional recommendation.
4.0 RANDOM TESTING FOR DRUGS
Employers complain about economic losses due to lower performance
of workers addicted to alcohol and drugs and they would like to identify such workers and terminate them or send them to treatment
facilities. Random testing of drugs usually in urine can serve this purpose since the employee never knows when he will be
tested and therefore has to keep away from drugs in order not to lose his job. Some jobs are so sensitive that any workers
who are addicted to alcohol or drugs could be a risk to themselves and others. Routine unannounced drug testing therefore
becomes necessary to prevent addiction. Workers should be informed of drug testing policies as part of their employment. However
when testing is going to be carried out a new informed consent is needed. When workers provide a sample for some other purpose
it should not be tested for drugs without consent. If a sample is found positive for drug the employee is informed and permission
is sought to disclose to management. If permission is not given, the attending physician can just report refusal of consent
to disclose. If there is immediate risk to the worker of others from lack of disclosure the physician may report to management
that the worker is not fit to work in which case he will be removed from the workplace and the risk will be averted.
5.0 REMOVAL OF WORKPLACE HAZARDSThe physician may advise about removal of a workplace hazard
to protect the employees but the employer refuses because of the cost implications. If the employer refuses to accept advice
about workplace hazards the occupational health physician is duty-bound to inform enforcement authorities.