Problems of the physical examination on the workers employed in industry

Abstract

1. A critical appraisal of periodic physical examinations in occupational health practice is attempted discussing some specific aspects of the industrial health maintenance program in Japan. The periodic physical examination of the country have mainly been done to detect a limited number of patients of chronic non-occupational illness. This is because the detection and control of tuberculous patients have long been the major concern of the industrial health service. Experiences since pre-war days of periodic examinations providing tests of detecting tuberculosis may have resulted in application of periodic examinations pertaining almost exclusively to chronic adult diseases which are detectable in terms of diagnostic screening tests. 2. Legal provisions on periodic health checks back to 1929. The original provisions paid special attention to the relevance to workers' health of various occupational hazards and stresses, but they were realized only incompletely in the industrial practice. In contrast to widely distributed periodic examinations for the control of tuberculosis and some other non-occupational chronic diseases, the impact of environmental factors, especially those born of the recent technological innovation, upon workers have been made light of special tests provided periodically for workers exposed to specific toxic agents, on the other hand, have usually no essential relation to the periodic health appraisal mandatory for all employees. Some social backgrounds promoting such a tendency should be taken into account. 3. It should be noted that the periodic physical examination is in general the major and often the only activity of health service within enterprises. The part of an industrial physician or a health service staff, however, must be combined with competence in utilization of individual and collective data that pertain to the qualities of the occupational environment as a whole. The tendency to evaluate environmental effects only through detection of chronic illness which are definable by limited and specialized testings may have resulted also from the past policies of occupational health administration. In not a few cases, the periodic application of formulated physical examinations goes ahead of a fair grasp of occupational health risks existing in workplaces, so that the absence of abnormal test results is very often considered as an evidence of acceptable working conditions. 4. Reassessment of the multi-item mass screening system in periodic health appraisal, planning of a more efficient health examination system, including reduction of roentgenological exposure, and re-education of industrial physicians and other health service personnel are urgent problems. In brief, the periodic physical examination system for industrial workers is at an important turning-point. © 1974, Japan Society for Occupational Health. All rights reserved.