Medical management of lead-exposed workers: results of physician interviews in New Jersey

Between July 1990 and April 1992, a questionnaire was administered to the physicians who saw 62 individuals with a blood lead (PbB) level equal to or higher than 2.40 mumol/liter with occupational inorganic lead exposure, to ascertain the medical management of workers with elevated PbB levels. Most of the 62 cases were seen by their personal physician (50%) or a private physician under contract with the company for which the patient worked (40%). Only eight (13%) patients were seen by a physician in a medical specialty assumed to include training relevant to occupational lead exposure. Fifteen percent of the patients' physicians reported taking no action for the elevated PbB level. Twenty-nine percent did not report retesting the patient (all should have been retested). Twenty-one percent of the 62 patients' physicians reported informing no one, including the patient, of the elevated PbB level. The majority of the physicians did not know the answer or declined to answer a question about what PbB level would prompt them to take six follow-up actions. The results of the physician interviews indicate that medical follow-up on workers with elevated PbB levels may not be adequate to prevent lead poisoning of the workers and their co-workers. Recommendations include methods to increase physician and employer knowledge of the medical management of workers with elevated PbB levels and to increase employer compliance with OSHA standards regarding medical surveillance of lead-exposed workers.