In this issue of Occupational Medicine
Honorary Editor
Employment tribunals are a topic of perennial fascination to occupational physicians even when very few cases actually make it to tribunal or involve occupational physicians when they do. On the other hand, meaningful analysis as to how tribunals behave and interpret the Disability Discrimination Act is scarce and therefore any research that examines tribunal behaviour is welcome. Williams [1] looked at almost 2500 disability discrimination tribunal cases during 2005/06. Ninety-one per cent were withdrawn or settled before going to court and of the 226 that did make it, only 49 (2%) had full hearings available for examination. Of these, only 19 cases had the benefit of advice from an occupational physician, of whom four were consultants. Where there was involvement of an occupational physician, there was more likely to be advice on adjustments and subsequent dismissal that discrimination had occurred. However, the author notes how difficult it was to obtain meaningful information from the cases studied, which suggests further research in an important area of practice might be difficult.
The issue of whether pre-employment medical assessment is effective continues to be debated and has also been critically examined in recent times in the UK by the now disbanded Disability Rights Commission. Moshe et al. [2] looked at almost 2000 pre-employment assessments comparing three different methods. Just >2% were restricted in some way as a result of assessment but there was no significant difference between the groups. They concluded that a questionnaire assessed by an occupational physician was as effective as examination by either an occupational physician or general practitioner.
Should military personnel about to enter conflict situations receive stress debriefing? Sharpley et al. [3] examined this question in 4000 military personnel about to enter active service in Iraq. Ninety-one stress briefs were administered by either a psychiatrist or a mental health nurse. While there were some age and rank difference in those who attended briefs compared to those who did not and attendees were more likely to have traumatic experiences, there were no differences in long-term mental health as followed up 2–3 years later. The authors conclude that stress education briefing should not be considered as part of an employer's duty of care.
Doctors are often cited as an occupational group with high suicide rates and previous studies in California, England and Wales and Denmark have found elevated rates for male physicians. Petersen et al. [4] extended previous work to look at suicide among doctors and dentists in 26 US states and were able to examine 264 suicides in total over a 9-year period. Suicide rates were similar in white male doctors and dentists and lower than expected against the population rate although suicide rates increased significantly with age. Female doctor suicide rates, however, were over twice that expected against the US population and the authors suggest this needs further investigation.
In a literature review, Cosgrove [5] considered the question whether work-related stress might precipitate type 2 diabetes. The presence of depression or depressive symptoms was associated with increased risk of subsequently developing diabetes with a relative risk of 1.25 (95% CI: 1.02–1.48). This means that 20% of cases of diabetes can be attributed to depression in people with both conditions and further research should consider possible causal mechanisms for the association. However, the author was unable to find evidence that depression could cause diabetes and makes recommendation regarding the award of injury benefits.
Elsewhere in the journal, in a viewpoint article, Poole [6] explores the difficulties surrounding clusters of occupational mental ill-health and make sure you read Andy Slovak's fascinating account of why he became an occupational physician [7].
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References |
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 Top References |
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- Williams AN. Are tribunals given appropriate and sufficient evidence for disability claims? Occup Med (Lond) (2008) 58:35–40.
- Moshe S, Shilo M, Yagev Y, et al. Comparison of three methods of pre-employment medical evaluations. Occup Med (Lond) (2008) 58:46–51.
- Sharpley JG, Fear NT, Greenberg N, Jones M, Wessely S. Pre-deployment stress briefing: does it have an effect? Occup Med (Lond) (2008) 58:30–34.
- Petersen MR, Burnett CA. The suicide mortality of working physicians and dentists. Occup Med (Lond) (2008) 58:25–29.
- Cosgrove MP, Sargeant LA, Griffin SJ. Does depression increase the risk of developing type 2 diabetes? Occup Med (Lond) (2008) 58:7–14.
- Poole CJM. Safe systems of work are needed for the diagnosis of occupational mental illness. Occup Med (Lond) (2008) 58:5–6.
- Slovak A. Why I became an occupational physician .... Occup Med (Lond) (2008) 58:4.
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