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DogLovingPA

Medical history on work physical

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I work in an urgent care setting where we occasionally perform basic employment physicals.  Had a new company today that I had never done a physical for and on their form they had a spot for "communicable diseases".  The patient indicated a disease to me (think chronic, 'private' disease) that they are medicated for prn.  I included this on the form but when the nurse went to discharge them, they were quite upset that I had recorded that part of their history.  They walked out before I could talk to them about it but am wondering what other's thoughts were on this.  On one hand - it is a section of the required physical form and part of their medical history.  However, I also see the patient's point of view that this is a more private healthcare matter and they don't think their employer has any right to this information.  Would you have listed it on the form?

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I work in an Urgent Care, and I also do work for Occupational Medicine. I think that part of the issue here is that you haven't been given direction or background information about this... and I think your group would benefit from establishing some.

 

Short answer: I would not have listed it on the form. I would document in terms of "history, meds, and allergies were reviewed, and in terms of issues that would be expected to be relevant to the performance of job duties, there are none." There is no reason why the employer needs to know these particular details of this person's medical history (unless you're in Nevada, and doing a pre-employment exam for a new worker at the Bunny Ranch).

 

In the OEM setting, it's understood that the "doctor-patient relationship" is different, and in a sense doesn't actually exist. You're evaluating someone for their suitability to perform the tasks associated with doing a specific job, and you're helping the client company make determinations about their new employees (who in some cases are still potential employees). In a more extreme case like a DOT physical for a commercial driver, you have an even bigger responsibility in terms of keeping unsafe drivers off the roads (people with seizure disorders, people who might suddenly become incapacitated by uncontrolled blood sugar, etc).

 

This is totally different from most Urgent Care issues, even sports or camp physicals. When I work in OEM, our Epic has a check-box on the history screen that is toggled on, so I'm not even looking at any history inside our own organization that isn't Occ Med history. And I should have a good reason for un-checking that box, before I do it and go looking for more detail on a given issue.

 

Meanwhile in UC, I'm all over it, because I want to know as much as I can about the patient and their history. For an employment physical, I'm working for the company, not the patient, and that's the important distinction.

 

If they're going to be operating a drill press and they've had shoulder surgery in the past, list it. If they're going to be working on a dock and have had 3 rounds of PT for back pain, list it. If they're going to be a greenskeeper at the municipal golf course and they've had 2 gout flares in the past 5 yearts, list it. Stuff like that.

 

But it's not fair of your employer to just throw this stuff at you and imply you need to use your best judgement if no one has ever laid out the purpose of these exams, or the guidelines for deciding how and what to include in your documenting.

 

So, you did fine in terms of the typical Urgent Care note... but this sounds like it wasn't the typical Urgent Care exam.

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Thanks for the thoughts Febrifuge.  This was perhaps the strangest physical form I'd ever seen from an employer.  And we aren't actually clearing them for the job - just performing the exam and reporting what we find back to the employers who make the determination.  All these folks had in the exam portion was basic vitals/stats/vision and then throat, heart, abdomen.  That was it!  And then a page and a half of medical history questions.  Strangest thing I've ever seen.  Lol.  In retrospect, I wish the patient hadn't left so I could of adjusted the form for them (although the doc I was on with thought it should stay).  When they told me I was just in automatic mode and wrote it down without thinking about it..... but in retrospect I don't see how this was relevant to their employment (they were being in employed in health care but I don't think this was the kind of communicable disease the employer is worried about). 

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The company form should have indicated if you needed to record the patients TB status as that might be what the company was implying on the form.  

 

I do a few of these exams for students going into a health field and the school requires it, or exams where the patient might indicate they have a latex allergy and I have to verify that!  How do I verify a latex allergy....rub a latex glove on their face and see what happens????

 

The worst of all is the line...does the patient have any communicable diseases (with no qualifiers to explain what is meant)?  How do I know?????  Unless I see a history or MRSA, Hep C, HIV or history of TB I write in a note that says "There is no evidence of communicable diseases per review of chart and per patient's report".

 

Some of my patients have never been to our clinic and we have no records so that is why I use the above statement. 

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Paula - there was a spot to record a negative PPD as well on the form.  I forgot to mention that. 

 

At least I didn't have to verify allergies - um what?!!!  We are in the same spot here - as urgent care these folks just walk in off the street and all the history we have on them is what they tell us. 

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It wouldn't be the worst idea ever to check with someone in charge, and/or someone in your Legal department, to see if it's even legal for an employer to ask some of those questions. I'm far from an expert, but I think the general principle is there should be a work-related rationale for needing to know.

 

And fair enough, they're not asking you to make the employment determination, but functionally it's really very similar. They're asking you to evaluate the person's health, and they're using that (presumably) to finish up the process of hiring - or keeping - the person.

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Some employers have not updated their forms since the 1960s. Not kidding.

 

I just did a DOD physical on a retired Vietnam Vet to go to Japan for "security" training. This guy just oozed Blackwater black ops vibes - very weird.

 

The DOD forms were unbelievably bad - the bottom right corner of the form showed "Rev date 6/1969" - I am not kidding.

 

The form had STD questions and vague references to mental stability and psychosis. Completely inappropriate and out of date but all I had to work with.

 

A lot of employers have no idea what they are doing or what is legal, ethical etc. Someone somewhere got this physical form going and no one ever changed it or looked at it.

 

Read a current DOT physical form - it isn't great either - Yes or No and NO is normal - huh?

 

So, do right by the patient, I always say and, I agree, if it doesn't apply to the job activity, it is not the employer's business.

 

We also just had a guy walk in wanting a physical to clear him to swim the English Channel. No guidelines - just a very badly photocopied, crooked copy with one paragraph and a space for medical provider signature stating this person could "attempt" to swim the channel.

 

We deferred him from our walk in clinic and stated he would have to establish with a PCP to have PFTs, EKG etc to get this kind of clearance. The guy is not a swimmer by sport and had never done a triathalon much less marathon. A walk in UC clinic is NOT the place for these kind of physicals.....

 

My 2 cents

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I work in an urgent care setting where we occasionally perform basic employment physicals.  Had a new company today that I had never done a physical for and on their form they had a spot for "communicable diseases".  The patient indicated a disease to me (think chronic, 'private' disease) that they are medicated for prn.  I included this on the form but when the nurse went to discharge them, they were quite upset that I had recorded that part of their history.  They walked out before I could talk to them about it but am wondering what other's thoughts were on this.  On one hand - it is a section of the required physical form and part of their medical history.  However, I also see the patient's point of view that this is a more private healthcare matter and they don't think their employer has any right to this information.  Would you have listed it on the form?

 

I never release PMH on employer forms. it is HIPPA-protected information and can be used against employees. sometimes patients ask me for "a printout" of the physical exam to take to their employer, and I educate them as to the private status of most of their PMH.

 

I think for employment purposes, they are looking for TB or vaccinations that are not up to date (varicella; MMR, etc).

 

I'm guessing, but if you put on a patient's work form that they are HIV (+) then shame on you. this is utterly private information, and you may have unleashed extremely private and sensitive PMH into the public domain, not only for that job, but in general.  

 

(+) HPV or herpes, also: SO not relevant to an pt's employment form. again: PRIVATE!

 

use your brain!

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Some employers have not updated their forms since the 1960s. Not kidding.

 

I just did a DOD physical on a retired Vietnam Vet to go to Japan for "security" training. This guy just oozed Blackwater black ops vibes - very weird.

 

The DOD forms were unbelievably bad - the bottom right corner of the form showed "Rev date 6/1969" - I am not kidding.

 

The form had STD questions and vague references to mental stability and psychosis. Completely inappropriate and out of date but all I had to work with.

 

A lot of employers have no idea what they are doing or what is legal, ethical etc. Someone somewhere got this physical form going and no one ever changed it or looked at it.

 

Read a current DOT physical form - it isn't great either - Yes or No and NO is normal - huh?

 

So, do right by the patient, I always say and, I agree, if it doesn't apply to the job activity, it is not the employer's business.

 

We also just had a guy walk in wanting a physical to clear him to swim the English Channel. No guidelines - just a very badly photocopied, crooked copy with one paragraph and a space for medical provider signature stating this person could "attempt" to swim the channel.

 

We deferred him from our walk in clinic and stated he would have to establish with a PCP to have PFTs, EKG etc to get this kind of clearance. The guy is not a swimmer by sport and had never done a triathalon much less marathon. A walk in UC clinic is NOT the place for these kind of physicals.....

 

My 2 cents

 

re channel-swimmer: what an idiot! 

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