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Agreement between UK Maritime Coastguard Agency medical referees
1University Hospitals Birmingham, Selly Oak - Occupational Health Department, Birmingham, UK. isamrustom@gmail.com
Background:
The seafaring industry remains a hazardous occupation that requires sophisticated systems of risk and fitness assessment.
Aims:
To study the extent of agreement between the medical referees (MRs) and the determinants of agreement between the MRs.
Methods:
A total of 232,878 seafarer medical examinations were carried out by approved doctors (ADs) between 2003 and 2009. The extent of agreement between the MRs was studied in those cases considered by the MRs because the seafarer appealed against the AD's decision. The identified determinants of agreement between the MRs were analysed.
Results:
There were 465 appeal cases that covered all medical categories. Cardiovascular disease was the most frequent cause of appeal, in 31% (143) of cases. The MRs upgraded the seafarer's fitness category in 58% (271) of cases, upheld the initial AD's decision in 40% (184) and downgraded the seafarer's fitness category in only 2% (10) of cases. There was no statistically significant difference between the MRs when they assessed the fitness of seafarers.
Conclusions:
MRs seemed to agree with each other as they upgraded the fitness category of seafarers to allow more of them to work at sea. It appears that the outcome of the appeal process was multifactorial and was affected by a combination of multiple variables.
Insights
Medical referees (MRs) generally agreed when reviewing seafarer fitness appeals, frequently upgrading fitness categories. This suggests a consistent approach in assessing seafarer employability in the maritime industry.
Area of Science:
- Maritime Health
- Occupational Medicine
- Medical Assessment
Background:
- The seafaring industry presents significant occupational hazards.
- Robust risk and fitness assessment systems are crucial for seafarer safety.
- Evaluating the consistency of medical assessments is vital for fair practice.
Purpose of the Study:
- To determine the level of agreement among medical referees (MRs).
- To identify factors influencing agreement between MRs in seafarer fitness assessments.
Main Methods:
- Analysis of 465 seafarer appeal cases from 232,878 medical examinations (2003-2009).
- Focus on cases where seafarers appealed decisions by approved doctors (ADs).
- Statistical analysis of MR agreement and influencing determinants.
Main Results:
- Cardiovascular disease was the leading reason for appeals (31%).
- MRs upgraded seafarer fitness in 58% of cases.
- No statistically significant disagreement was found between MRs' assessments.
Conclusions:
- Medical referees demonstrated substantial agreement in their assessments.
- The appeal process frequently resulted in upgraded fitness categories for seafarers.
- Outcomes of appeals are influenced by multiple, interacting variables.
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