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 HAZARDS
The 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.