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Pre-employment physicals


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Hi all. When doing pre-employment physicals, I generally do a thorough hx and exam and screen for TB. My question is, do you guys order any other labs i.e. titers for MMR/varicella, routine bloodwork like CBC, CMP, lipid panel, TSH, etc? The patients also don't bring immunization records or are often unaware of their immunization status- are u suppose to give them Tdap/flu shot anyway? Their paperwork doesn't specify what exactly they want in terms of labwork and immunizations. They just want to know if physical and history is generally normal. Any feedback?

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This really depends on what sort of pre-employment physicals you're conducting.  Remember, the subject of the exam is not your patient, the company paying for the exam is your client.  That may seem like a meaningless distinction, but the fiduciary relationship means you have to tell the truth against the best interests of the subject because it's what your client is paying you for.

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I see more and more employers doing some sort of pre-employment to weed out mental issues and chronic physical issues so as to avoid hiring someone who will eventually file a workers' comp claim or go out on disability or generally be a pain in the butt and not be able to do everything needed for the job.

 

I have seen this happen with local companies and even schools. Someone with a past gets a job and then suddenly is unable to pick up a case of copier paper or calls in sick a bunch and  then discloses 3 failed back surgeries and chronic oxycodone use. 

 

If you find a pre-employment patient on a ton of psych meds - not sure how to address it outside of DOT or physically dangerous jobs - but, in all honesty - would I want my toddler with someone all day who is on sedating drugs or those dependent on a steady drug level???

 

There have been lots of cases in the media of the No One Would Ever Have Suspected This Person of Being a….. insert label - pedophile, suicidal, unmedicated schizophrenic, etc.  

 

I am guessing that employers want to separate themselves from these candidates ahead of time or claim limited knowledge if they lie about conditions, etc.

 

Yep, I don't see any truly virtuous reasons for these physicals other than legal.

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Guest Paula

I've done plenty of pre-employment physicals for "pre-school" teachers.  They were for the Head Start program and the "pre-school teachers" were the glorified babysitters.  The pre-school teachers had to have a physical every year.  I just made it into their annual exam.  The exams were required so the program could stay  certified and get funding, they really didn't care how healthy they were.

 

This was on the reservation...........

 

The physicals were free.  We didn't get reimbursed by Head Start unless the patient had insurance and many didn't.

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