The occupational history: a neglected area in the clinical history

The need for detailed occupational histories has been demonstrated by the occurrence of 100,000 deaths from, and 390,000 new cases of, occupational disease each year. Work generated illness takes the form of serious involvement of all bodily organ systems and, in addition, can present as the ill effects of carcinogenesis, mutagenesis, and teratogenesis. Monographic writings on physical diagnosis and family medicine have failed to give emphasis to a substantial description of the patient's employment and its health effects. Such a complete occupational medical history has as its primary objectives the improvement of medical care and the return of the worker to gainful employment. The elaboration of such a history involves inquiry into all past work performed, the development of symptoms, the health of fellow workers, and knowledge of the preventive medical program offered at the worksite. A detailed work history will aid the primary care physician in the rendering of more intelligent preventive medical attention to the wage earner-patient.