The general practitioners' view

Awareness, knowledge and training gaps regarding asbestos among General Practitioners: a pilot study

General Practitioners (GPs) have good knowledge of health status and sociocultural backgrounds of their patients, thus could be decisive in early detection of cases of asbestos-related diseases (ARDs). In this cross-sectional pilot study, we investigated perception and knowledge on asbestos risk amongst a sample of GPs practicing in Molise region, central Italy, who have anonymously completed a 29-items questionnaire specifically developed for this research. Based on GPs’ answers, we obtained scores and classified awareness and knowledge into four percentage quartile classes including inadequate (0-24%), poor (25-49%), moderate (50-74%) and high (75-100%), and scarce (0-24%), sufficient (25-49%), good (50-74%) and optimal (75-100%), respectively. Twenty-eight GPs (median age 63 years; 82% male) participated. Perception and knowledge among participants varied from 62 to 84% and from 18 to 42%, respectively, with 65 and 42% showing an adequate level, respectively. Our survey revealed a satisfactory perception and knowledge of general features about this topic, while a poor awareness of detailed aspects, underlining the need of continuing medical education in the field of occupational medicine. The study remarks that criteria for ARDs diagnosis should be better specified, introducing a detailed list to harmonize medical protocols for symptoms identification and patients’ examination. Hence, increasing awareness of asbestos risk and ARDs among GPs represents a crucial opportunity, because of their prominent position to promptly take care of patients and provide targeted information.

Misdiagnosis in occupational and environmental medicine: a scoping review

Introduction

There has been no comprehensive review for misdiagnosis in Occupational and Environmental Medicine (OEM). The possible ramifications of an occupational disease (OD) or an environmental disease (ED) misdiagnosis are not just confined to the individual case but may extend to others exposed to the occupational or environmental hazard. Therefore, a comprehensive scoping review of published literature is imperative for understanding the nature of misdiagnoses in OEM.

Methods

A medical librarian searched MEDLINE (PubMed), EMBASE, and the Cochrane Library (on 06 November 2020). All collected OEM misdiagnoses were classified based on 2 conceptual frameworks, the typical framework, and the causation model. The distribution of misdiagnosis across each medical specialty, each diagnostic step of the typical framework and the causation model, and false-negative and false-positive were summarized.

Results

A total of 79 articles were included in the scoping review. For clinical specialty, pulmonology (30 articles) and dermatology or allergy (13 articles) was most frequent and second-most frequent, respectively. For each disease, occupational and environmental interstitial lung diseases, misdiagnosed as sarcoidosis (8 articles), and other lung diseases (8 articles) were most frequent. For the typical framework, the most vulnerable step was the first step, evidence of a disease (38 articles). For the causation model, the first step, knowledge base, was the most vulnerable step (42 articles). For reported articles, the frequency of false-negative (55 articles) outnumbered the frequency of false-positive (15 articles).

Discussion

In OEM, compared to general medicine, causal misdiagnosis associated with the probability of causation is also important. For making a diagnosis in OEM, a knowledge base about possible ODs and EDs is essential. Because of this reason, the education and training of treating physicians for common ODs and EDs are important. For ODs and EDs, various intentional behaviors of stakeholders should be considered. This scoping review might contribute to the improvement of understanding for misdiagnosis in OEM.

Supplementary Information

The online version contains Supplementary theoretical review and Supplementary materials available at 10.1186/s12995-021-00325-z.

Collaboration between general practitioners and occupational physicians: a comparison of the results of two national surveys in France

OBJECTIVE

To study the perceptions that general practitioners (GPs) and occupational physicians (OPs) have of GPs' role in occupational health and their willingness to work together to prevent the exclusion of patients with disabilities from the workplace.

METHODS

Cross-sectional telephone survey of two randomly selected national samples of GPs and OPs was conducted.

RESULTS

The majority of GPs and OPs are in favor of cooperation, especially to prevent exclusion from the workplace. However, some GPs lack trust in OPs' independence, an attitude associated negatively with the practice of GP referral to OPs to anticipate disability-related problems likely to occur when returning to work after a prolonged sick leave.

CONCLUSIONS

There are some barriers to cooperation, on the part of both OPs and GPs. Initiatives are needed to encourage cooperation between these two types of physicians.

Optimal communication from occupational physicians to GPs: a cross-sectional survey

BACKGROUND

Correspondence from occupational physicians to GPs is infrequent, despite evidence that good communication leads to earlier return to work of sick-listed patients and is cost effective.

AIM

To explore the circumstances, content, and preferred method of communication GPs would value from an occupational physician, following an occupational health consultation with one of their patients.

DESIGN AND SETTING

A cross-sectional survey in the UK.

METHOD

A questionnaire was developed de novo, piloted, and sent to 600 GPs of consecutive employees undergoing occupational physician assessments. Descriptive data were generated using Excel.

RESULTS

The response rate was 374/600 (62%). Demographic features of GP responders reflected national figures. A total of 372 (99.5%) GPs wanted information from occupational physicians. Most wanted information on diagnosis (303, 81%), clinical assessment (275, 74%), functional assessment (295, 79%), or advice on the timing (308, 82%) and adjustments 290 (78%) of any return-to-work plan. Over 80% wanted information following every occupational physician consultation, and over 90% wanted information on the timing of a return to work, adjustments suggested, or if different medical diagnosis or management was suggested. The preferred method of communication was letter by post 341/374 (92%). Brief, relevant information was valued and considered useful for completing 'fit notes'.

CONCLUSION

Occupational physicians should send formal letters, by post, to the patient's GP following occupational health assessments. This would assist the GP in completing the patient's 'fit note' and ultimately increase the chances of their patient being rehabilitated back to work.

Work-related sickness absence negotiations: GPs' qualitative perspectives

BACKGROUND

GPs can find their role as issuers of sickness certification problematic, particularly in trying to maintain a balance between certifying absence and preserving the doctor-patient relationship. Little research has been published on consultations in which sickness absence has been certified.

AIM

To explore negotiations between GPs and patients in sickness absence certification, including how occupational health training may affect this process.

METHOD

A qualitative study was undertaken with GPs trained in occupational health who also participate in a UK wide surveillance scheme studying work-related ill-health. Telephone interviews were conducted with 31 GPs who had reported cases with associated sickness absence.

RESULTS

Work-related sickness absence and patients' requests for a 'sick note' vary by diagnosis. Some GPs felt their role as patient advocate was of utmost importance, and issue certificates on a patient's request, whereas others offer more resistance through a greater understanding of issues surrounding work and health acquired through occupational health training. GPs felt that their training helped them to challenge beliefs about absence from work being beneficial to patients experiencing ill-health; they felt better equipped to consider patients' fitness for work, and issued fewer certificates as a result of this.

CONCLUSION

Complex issues surround GPs' role in the sickness-certification process, particularly when determining the patient's ability to work while maintaining a healthy doctor-patient relationship. This study demonstrates the potential impact of occupational health training for GPs, particularly in light of changes to the medical statement introduced in 2010.

Work-related ill health in general practice, as reported to a UK-wide surveillance scheme

GPs with training in occupational medicine report cases of work-related ill health and sickness absence to The Health and Occupation Reporting network in General Practice (THOR-GP) using an online webform. This report describes the data reported in 2006 and 2007. GPs mainly reported musculoskeletal disorders and mental ill-health. A much larger proportion of the mental ill-health cases were sickness-absence certified, making up 55.9% of the total days certified. Musculoskeletal disorders are the most frequently reported diagnoses of work-related ill health, but mental ill-health is responsible for most work-related sickness absence.

Medical care of employees long-term sick listed due to mental health problems: a cohort study to describe and compare the care of the occupational physician and the general practitioner

OBJECTIVES

To describe medical management by the general practitioner (GP) and occupational physician (OP) of workers sick listed due to mental health problems, and to determine agreement in diagnosis, main cause of sickness absence and obstacles in return to work.

METHODS

A cohort of 555 employees being sick listed for 12 to 20 weeks due to mental health problems was recruited and followed for 1 year. These employees were interviewed about their mental health and contacts with GP, OP, other specialists and employer. In addition, the GP and/or the OP of 72 employees were interviewed about the medical diagnosis and management.

RESULTS

Most employees sick listed for 12-20 weeks visited their GP and OP. According to the employees most interventions applied by the GP were medical interventions, such as referral of employees and prescription of medical drugs. Working conditions were seldom discussed by the GP and work-related interventions were never applied. Most interventions applied by the OP were work-related interventions and/or contact with the employer. The OP more often talked about working conditions and conflicts. According to the employees, the communication between GP and OP only took place in 8% of the cases. Agreement in the diagnosis, main cause of sickness absence, and obstacles in return to work reported by the GPs and OPs of the same employee was poor. In addition, similarity in reported diagnosis by GP and/or OP and the employees' scores on valid questionnaires on (mental) health was limited.

CONCLUSIONS

The lack of communication and agreement by Dutch GPs and OPs in medical diagnosis and management of employees long-term sick listed due to mental health problems are indicators of sub-optimal medical treatment and return-to-work strategies.