Where’s the evidence? Pre-placement exams lack consensus risk analysis protocols
OSHA has medical screening and surveillance requirements for 24 standards, including asbestos, bloodborne pathogens, cotton dust, HAZWOPER, lead, noise and respiratory protection. Twenty of these standards call for pre-placement examinations. Pre-placement exams depend on specific factors cited in the standard, such as airborne concentrations of the regulated substance and/or years of exposure, amount of time exposed per year, and the age of the employee.
Is the individual fit?
Pre-employment or pre-placement medical exams are intended to place and maintain employees in jobs and work environments suited to their physiological and psychological capacities, according to the World Health Organization (WHO). Though OSHA has no requirements for psychological evaluations. The goal of these exams is to determine if an individual is fit to perform his or her job without risk to himself or others.
The growth of drug testing
About 80 percent of drug testing worldwide occurs as part of a pre-employment process, according to the International Labour Organization. Pre-employment drug testing is conducted by 98 percent of companies in the U.S., compared to only three percent in 1986. Surveys have found that people with substance abuse problems experience significantly more disability days that the rest of the population, but 80 percent of companies conducting pre-employment drug testing acknowledge that they have never analyzed the cost-effectiveness of this testing. One analysis cited by the WHO concluded that it cost a U.S. company $77,000 to find one substance abuser during the pre-employment process.
A WHO 2009 bulletin, “Evidence base for pre-employment medical screening,” states, “It appears that pre-employment testing has no impact on reducing absenteeism, and one medical authority suggests there is insufficient support for drug testing programs as pre-employment tools.
A ritualistic “need to do something”
WHO goes even further, stating that the “ritualistic use of pre-employment examinations might occur because much occupational practice is driven by a ‘compliance mentality’.” Occupational physicians and their employers are often “simply enmeshed in a cultural tradition that also has intuitive appeal, driving by ‘the need to do something’.”
The pre-employment chest X-ray is one medical assessment exam that has come under scrutiny. An empirical analysis of the efficacy of chest X-rays concluded that the practice was unnecessary and wasteful. Another study examined the value of both pre-employment and periodic follow-up medical assessment exams and found that only 1.7 percent of exams resulted in significant diagnoses.
Evaluating physical capacity
WHO states that physical capacity is essential for highly demanding occupations, especially when public safety is involved. But physicians required to evaluate medical risk in the workplace are hamstrung by the lack of consensus-based best practices and clinical trials, and generally accepted strategy or evidence-based strategy for these analyses. WHO contends that medical exams are only justified when a job involves working in hazardous environments, requires high standards of fitness, is required by law or when the safety of other workers or the public is concerned.
A health assessment by questionnaire should suffice in many cases, according to WHO. A job applicant can complete a medical history form which will be reviewed by a medical examiner, who discusses risk factors and strategies for health promotion with the applicant. A case-specific assessment of risk is recommended by WHO, requiring knowledge of relevant medical history, the proposed job, a job-demands analysis, and the work location.