| Patient presenting with new clinical problem | Is this patient currently working? Doing what? In what type of industry? What type of conditions? | What work do you do? Do you have a job? What is your job? What do you do for a living?
Is it full time or part time? How long have you been doing this job? In what year and month did you start? How long is your working day? Do you do shifts and what is the shift rotation? What is a typical working day for you?
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| The clinical problem could be work-relateda | Check possible work exposures to relevant chemicals, biological agents, physical strains or noise |
What tasks do you do (lifting / twisting / working with arms above shoulder height)? What processes do you work with? How often? For how long each day? What materials do you work with? Do you have or have you had occupational exposure to fumes, chemicals, dust, loud noises, vibration, radiation or other occupational hazards?
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| Elicited suggestion of relevant exposure to the current clinical problem | How might the patient have been exposed? How often? Are relevant controls in place? |
Have you been told that any of these might make you ill, that is, are hazardous? How might you be exposed to this hazard? What is the extent of your exposure to these materials? How is exposure controlled? Is there local extractor ventilation? Do you wear special protective clothing? Do you have any special medical tests because of this work?
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| Establishing relationship between work and the clinical problem | Temporality, dose-response, reversibility, strength of association and specificity |
When in relation to the exposure do/did the symptoms start? Are the symptoms notably worse when you are working for longer in higher risk areas? Are you better at the weekend or on holidays? Does anyone at work have the same symptoms or other health problems? Could any other exposure explain the symptoms (eg smoking)?
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| Establishing whether the exposure is relevant to the current main job | Many people work more than one job at the same time. Casual ‘cash in hand’ work may be more hazardous! Exposure may be from past work: take full chronological occupational history to be sure |
Do you have a second (or third) job? Have you done this type of work elsewhere in the past? Have you done any other kind of work? What jobs have you had since you left school?
If employment gaps:
Prison? Armed forces? Worked overseas?
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| Could the exposure be from outside work? | Exposures outside work are not necessarily risk assessed or controlled |
How do you spend your free time? What are your hobbies? What DIY or housework do you do (ie exposure to birds, adhesives or fumes)? Do any of these hobbies or activities bring you into contact with chemicals, impure chemicals or breakdown products?
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| If the clinical problem is ‘work-related’, how will the employee and employer likely respond?a | If ‘work-related’, management of the clinical problem is likely to rely on effective collaboration between doctor(s), employee and employer
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What is the patient's attitude? What might be the employer's attitude? What resources and expertise may be available to provide further information or to assist rehabilitation?
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