Introduction

Reviews

Is Your Doctor Misdiagnosing Environmental- and Job-Related Illnesses?

Timothy B. McCall, M.D.

When some people say, “My job makes me sick,” they mean it. Each year in the United States, over 50,000 people die of job-related medical conditions. Another 350,000 people become ill because of their work. Occupational diseases are often misdiagnosed and when the connection between your job and your symptoms is missed, so is the opportunity to treat you properly or to prevent further problems.

Job-related medical problems span a wide range—from lung cancer due to asbestos exposure, to fatigue from working the night shift at the factory or hospital, to carpal tunnel syndrome (a nerve problem causing numbness and pain in the hands) from typing at a keyboard too much. Unfortunately, the average U.S. medical student gets about four hours of training in occupational medicine during four years of medical school. The result is that most doctors, except for the few who've taken the time to learn on their own, know little about job-related illness.

Your primary care doctor should incorporate a few questions concerning your work into your initial interview, because—as with most medical problems—the interview is the best tool to diagnose job-related illness. Some of the things the doctor should ask include the following:

• What do you do for work? How long have you done it? How stressful is it?
• What are your working conditions like? Do you lift heavy boxes? Apply pesticides to the lawn? Sit at a desk all day and type? If you are working in hazardous conditions, they may be able to suggest possible remedies or refer you to another doctor who can.
• Have you had any previous jobs that exposed you to hazardous conditions? Since some hazardous exposures may not cause problems for years down the line, doctors should also ask about any jobs you've had in the past where you might have been exposed to such things as chemicals or asbestos or loud noise.
• Is there any relationship between your job and your symptoms? If you are seeing a doctor for new symptoms that aren’t obviously explained, the doctor should ask if there is any association between them and your work. Some people who suffer from so-called “sick-building syndrome,” for example, get headaches and fatigue that start a few hours after they arrive at work and begin to breathe the stale air and fade a few hours after they go home. On weekends or if they work somewhere else for a day, they have no symptoms at all.

Environmental Illness

A doctor should also explore the potential link between your symptoms and your environment. In our modern world, most of us live surrounded by plastics, solvents, detergents and pesticides. In exploring unexplained symptoms, doctors should ask you what chemicals you come into contact with in your day-to-day life and what precautions you take against accidental exposure. They should ask too about your hobbies, as they can be a source of environmental illness—from the paint stripper you’ve been applying to that chest-of-drawers to the lead you use to fashion home-made fishing sinkers.

If a connection between your work or the environment and your symptoms seems likely, my advice is to ask your doctor for a referral to a specialist in Occupational medicine. They are the doctors best trained to deal with these problems.

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