A model comprehensive psychiatric fitness-for-duty evaluation

A three-pronged model for a comprehensive psychiatric fitness-for-duty evaluation is presented as a resource tool for occupational physicians in the evaluation of substance abuse. Specialized psychiatric evaluators can play a role in (1) rendering diagnosis and fitness-for-duty determinations, (2) recommending treatment and monitoring plans, and (3) offering remedies for improving the employee/employer and medical systems. The comprehensive evaluation is especially helpful in difficult-to-diagnose and complex cases. The author provides guidance for deciding when to refer, discusses issues of confidentiality, and lists indicators of substance abuse based on employee behavior/performance and medical signs and symptoms.