Document Edp0D18q6JpXMEr8va8zGbqKV

HS 0016009 National Fund for Medical Edu c ., 2 West [.6th Street, N. Y. 36 Z' :Osar Dr. Lunnettt . I hare just read with considerable interest tout article* "Hole of Envircmental Medicine In Industry", which appeared In the Kovsabar Issue of-FEDXCAL ULU2CS* Yor earhasl on the increasing importance of nan-occupational Illness* and consequent^ of tbs role of prorcsttlve medicine In industry is veil taken Xn our Rochester plants, for-every day of lost time duo to occupational injury or illness, there axe 60 days of absence due to rwrwocoupational Ulnaso and injury* For men, the figure Is IlhO, and for waaezi, 1:100. It is quite obvious v.ivaro a progran for tiie reduction of loot tine due to ilIrene will show "pay dirt1* : .hile I do not disagree with the basic qualifications for industrial physicians vrrJ-ch you have emphasised, 1 os wandering if, by certain oulsdons, you stay not have left an erroneous liapreecion Tou did not nerttion that, for tho fulltir physician in Industry, a considerable body of knowledge and skill Is needed vftloh cannot possibly bo acquired during our present undorgraduate nodical training* Xn addition, X seriously doubt that your implication in the sontenee, "V*e shall probably be able to depend on sanitary and safety engineers, the public health, authorities, and the chemist to identify these hasards..." will be realised for nany years X would agree that not every Industrial physician needs to becaos an expert toxicologist, but ha doss reed to know considerably noire about the specific hasards in his plant than the average piysioian practicing in that ccBRjunity - :. X believe that the majority of the fuU-tina industrial physicians nd?recognise the need for additional training at the postgraduate level for individuals entering Indhietrial'Medicine on a full^tis- basis. The excellent article by Ef* Earner on "Graduate Education In Industrial Madicira", appearing in the October 1953 issue of IKECSTSIAI* SDICI1E ASD SUHCEHY, cursairiaos the type of training which most of os who ere actively engaged in Industrial Medical Education agree is essential Xn the pact two years, we have had two Fellows for lrwplant training here In our plants, wboeaae from such a postgraduate training program One of these was from th1University of Cincinnati, the other froa the University of Pittsburgh, Their ability to handle the variety of problme encountered in Industrial Medicine cocrpares favox^ably with that which would ordinarily not develop until five or- ten yearn of ordinary on-thojob experience. Xn the c a m of an Individual working alone in Industrial Medicine, this period of time for equivalent development nay w l l be a much longer one. Tour qualifications are prerequisite to being a good, well-rounded, preventive medicine oriented doator, but the competent industrial physician mode considerably more* V^ wg ^ .^ EA ST M A N KODAK COM PAN Y, ROCH ESTER, N. Y. .V r t - * i _ .. . - .- - u t i ,j r ~ 1l l^rgt&ne and Toxicology, Epidooiologjr of Occupational Disease, .Applied Preventive hedicine, and other important subjects are treated in separate courses* mI recognise the difficulty in telling the whole story in a brief article* but apprehensive that many of the norwraedic&l people in industry to whoa this information goes, nay misinterpret the qualifications in this increasingly important area of practice* I an sure that many of the loaders in cur iJadlcal Schools are unaware of the active ckr/clopncntc in this field of post graduate medical education* It seems to no that, at a later date, the story of the progress of postgraduate training in Industrial Kcdicimo might be told in ISDXCAL AD7AKCS by eaasona such as Dr, ?!cbsrt Keho or Dr, Adolph Ksmner* This would clarify the picture which, X believe, is gaining increasing acceptance by active practitioners and educators in Industrial Hediclr* Very truly yours, JiSAC he* CC i f-r. 1H* , Kehoe > / Dr. A* G* Hbaer Abdicai Director EASTM AN KODAK COM PAN Y, ROCH ESTER, A n aggin g w ife, a sick ch ild, a m ortgage com in g due -- all cu t in to a w ork er's efficiency an d cost the em ploy er m on ey . D r. Bon n ett, a leadin g au th ority on in d u strial h ealth , su ggests th at in d u stry an d die m edical sch ools, together, can h elp the p h y sician o f the fu tu re m eet th is problem . I -*v \r\ (jr r : ml x i T u ^ q V 4 1953 E. U. S H E A ROLE OF ENVIRONMENTAL MEDICINE IN INDUSTRY by Dr. Earl C. Bon n ett Medical Director, Metropolitan Life In suran ce Company No person is ever free from his environment. His medical problems in the final analysis are an expression of his relation to the environment. The general tendency now seems to be to regard the complete and total individual, rather than his symp toms, as the primary concern of the physician. Certainly in industry the individual plus his surroundings is looming ever larger. Worries in the home -- a sick wife or a sick child, or a sick husband -- are, unfortunately, brought by the employee to his .job. He may, .in the course of a day, develop an acute appendicitis. But he is more likely to develop dizziness, an undiagnosed abdominal pain or diarrhea, or fight with his boss or a fellow worker. The same thing can happen if he is in financial difficulties or if his mortgage is about to be foreclosed, or if he has a psychological pattern which makes him grumble because of his surroundings and gripe at every order given by his supervisor. Of course, there are specific environmental hazards in industry. These will vary according to the type of industry and the products it manufactures. New methods will bring in new toxic materials, new accidental exposures, new forms of dermatitis In the face of disruptive fin an cial pressures, th e medical schools are strivin g to meet the needs of America's fam ilies an d comm un ities -- of in dustry, th e armed forces, research and public h ealth -- for ph ysician s an d oth er h ealth personnel. To help th em reach an un derstan din g of th ese n eeds, th e Nation al Fun d for Medical Education is bringing medical school officials together with in dustry an d comm un ity leaders in a series of m eetin gs th rough out th e country. Th is article, based on m a terial presented by th e auth or at one such m eetin g, discusses in du stry's m ost pressin g medical needs, now an d in th e fu tu re. N19838.01 Aim Now is Health Conservation; Employer in Best Position to Help In the main, they are satisfactory. An acutely ill person needing a hospital usually can be admitted. An injured person can receive first aid or hospitalization if necessary. Certainly, the doctor taking care of him should have enough diagnos tic ability and surgical understanding to separate the serious from the minor condi tions and advise proper care. ' In the last 25 years, there has been a great change in industry's attitude con cerning the health of employees. Life insurance, of course, needed doctors rather early in classifying risks for insurance. Manufacturers later needed doctors when Workmen's Compensation laws began to appear and there was need to reduce the cost of accidents and to identify and remove health hazards. Now, it is felt that there is increasing need for health conservation among employed persons and that the employer is in the best position to help the employed population in this effort. This attitude has meant quite a change in the point of view of practitioners who have been trained to treat the individual's symptoms but now, entering the in dustrial field, have the opportunity not of treating but of conserving the health of the active employee. I suspect strongly that most of the annual or periodic examinations designed to pick up early evidence of disease are today made by the company doctor on company time. Chronic Disease, Em otion al Reaction s are Ch ief Problems of In dustrial Medicine Today In approaching employee health conservation, the first problem is what to do about chronic disease and how to prevent it. Actually, there is very little that can be done at the present time except to detect tuberculosis early, to advise on weight reduction, to guide and counsel employees concerning good health habits and nutrition, to encourage proper eating and rest habits and to be on the lookout for the potential diabetic and the hypertensive among overweight individuals. Some disorders detected early can be favorably influenced or controlled. Perhaps some day we can find a method of utilizing social security numbers as a follow-up to learn, over the years, the natural history of the development of high blood pressure, coronary artery disease, or even cancer. This, of course, would require a fairly standard method of reporting the results of pre-employment exami nations or periodic health appraisal examinations. A great mass of data could be can recognize the interplay of stresses on these reactions and help the individual to an understanding and an insight into his behavior. . Plant Doctor of the Future Must Have Broad Understanding For this purpose, I would select a doctor with a warm personality and under standing who can sit down with the individual, canvass the whole environmental situ ation and help the individual, in a friendly but firm way, to recognize the true situation. Unfortunately, there are not too many of this kind of doctor at the moment and those available seem to have this capacity by endowment rather than by education. In environmental medicine we need to extend our activities and interests to the home. This may not always be feasible. It may even lead to widespread resentment because of the thought that the employer is getting too nosey. However, we must recognize that a lot of our problems are initiated and brought to full bloom in the family situation, although the employer bears the brunt of their manifestations. We need to assure ourselves that the truly sick person is kept off the job. We need to recognize that a person with a sick family or other severe home worries is not a well person. It is not he, however, who is in need of treatment, but the FU LL- TIM E PART- TIM E "ON CA LL" Percentage of 3,589 PHYSICIANS IN INDUSTRY SM ALL Plants {Employing Lass Thon 500) M EDIUM (Employing 500 to 1,000) 59% LA RG E (Employing More Than 2,500) 41% t. **'t' Less Than H of 1% 3% ISWM Hf 1% In a recen t survey by th e Nation al Association of M an ufacturers, more th an h alf th e 3,589 re spon din g com pan ies reported in plan t m edical services. In th e ch art above, th e first section (left) shows th e percen tage of all respon din g com pan ies employin g full-tim e, part-tim e an d /or "on call" ph ysician s. (The percen tage reportin g no m edical services is n ot shown.) Th e th ree sec tion s to th e righ t show th e percen tages for sm all, m ediu m an d large compan ies. Now the question naturally arises, where are we going to get doctors who have the knowledge and ability which industry needs? And get them in larger numbers as the need increases? Certainly, they should receive somewhere in their training an awareness of those large areas in which they will be of genuine service and still be real practicing physicians. Th is train in g, it seems to me, sh ould really come in the un dergraduate courses at the medical schools. The un dergraduate sh ould be m ade aware o f opportun ities in in dustry an d of th e psychological or emotion al problems of individuals working or living in difficult circum stan ces. His future private patien ts will ben efit too. The student should know, too, something of the economics of private practice and of the tremendous strides which have been made in recent years in insurance coverage. Doctors in industry generally are not aware of the advantages of certain kinds of insurance -- disability, medical and surgical care and hospitalization in surance -- which, not infrequently, supplies part or all of the funds their patients pay for wider, more complete medical service than they have been able to afford in the past. They should make it a point to know and be able to explain to their patients the advantages of these insurance plans, the many benefits available and how properly to utilize them. ' There is one final Qualification for the physicians who practice environmental medicine: warmth and understanding. The personality -- or at least some evaluation of the emotional and psychological adjustment of the student as a potential physi cian -- needs careful study in the selection of medical students. Sec. 34.65(e), P.L.&R. U. S. PO STAGE PAID New York, N . Y. Permit No. 2157 EDWARD L SH EA PRES ET H YL CORp 1 0 0 PARK a v e NEW YORK I 7 N Y K E 0016015 A n aggin g w ife, a sick child-, a m ortgage com in g due -- all cut in to a w ork er's efficien cy an d cost the em ploy er m oney. D r. Bon n ett, a leadin g au th ority on in d u strial h ealth , su ggests th at in d u stry an d the m edical sch ools, together, can h elp the p h y sician of the fu tu re m eet th is problem . ' ' ROLE OF ENVIRONMENTAL MEDICINE IN INDUSTRY by Dr. Earl C. Bon n ett Medical Director, Metropolitan Life In suran ce Company No person is ever free from his environment. His medical problems in the final analysis are an expression of his relation to the environment. The general tendency now seems to be to regard the complete and total individual, rather than his symp toms, as the primary concern of the physician. Certainly in industry the individual plus his surroundings is looming ever larger. Worries in the home -- a sick wife or a sick child, or a sick husband -- are, unfortunately, brought by the employee to his .job. He may, in the course of a day, develop an acute appendicitis. But he is more likely to develop dizziness, an undiagnosed abdominal pain or diarrhea, or fight with his boss or a fellow worker. The same thing can happen if he is in financial difficulties or if his mortgage is about to be foreclosed, or if he has a psychological pattern which makes him grumble because of his surroundings and gripe at every order given by his supervisor. Of course, there are specific environmental hazards in industry. These will vary according to the type of industry and the products it manufactures. New methods will bring in new toxic materials, new accidental exposures, new forms of dermatitis In th e face of disruptive fin an cial pressures, th e medical schools are striving to meet th e needs of Am erica's fam ilies an d comm un ities - - o f in dustry, th e arm ed forces, research an d public h ealth -- for ph ysician s an d oth er h ealth personnel. To h elp th em reach an un derstan din g of th ese needs, th e Nation al Fun d for Medical Education is bringing medical school officials togeth er with in dustry an d commun ity leaders in a series of. m eetin gs th rough out th e country. Th is article, based on m a terial presented by the-author at one such meetin g, discusses in dustry's m ost pressin g medical needs, now an d in th e future. throughout the nation, either through an inplant medical service or by an arrange ment made with local practicing physicians. Aim Now is Health Conservation; Employer in Best Position to Help ' In the main, they are satisfactory. An acutely ill person needing a hospital usually can be admitted. An injured person can receive first aid or hospitalization if necessary. Certainly, the doctor taking care of him should have enough diagnos tic ability and surgical understanding to separate the serious from the minor condi tions and advise proper care. In the last 25 years, there has been a great change in industry's attitude con cerning the health of employees. Life insurance, of course, needed doctors rather early in classifying risks for insurance. Manufacturers later needed doctors when Workmen's Compensation laws began to appear and there was need to reduce the cost of accidents and to identify and remove health hazards. Now, it is felt that there is increasing need for health conservation among employed persons and that the employer is in the best position to help the employed population in this effort. This attitude has meant quite a change in the point of view of practitioners who have been trained to treat the individual's symptoms but now, entering the in dustrial field, have the opportunity not of treating but of conserving the health of the active employee. I suspect strongly that most of the annual or periodic examinations designed to pick up early evidence of disease are today made by the company doctor on company time. Chronic Disease, Emotional Reaction s are Ch ief Problems of In dustrial Medicine Today In approaching employee health conservation, the first problem is what to do about chronic disease and how to prevent it. Actually, there is very little that can be done at the present time except to detect tuberculosis early, to advise on weight reduction, to guide and counsel employees concerning good health habits and nutrition, to encourage proper eating and rest habits and to be on the lookout for the potential diabetic and the hypertensive among overweight individuals. Some disorders detected early can be favorably influenced or controlled. Perhaps some day we can find a method of utilizing social security numbers as a follow-up to learn, over the years, the natural history of the development of high blood pressure, coronary artery disease, or even cancer. This, of course, would require a fairly standard method of reporting the results of pre--employment exami nations or periodic health appraisal examinations. A great mass of data could be can recognize the interplay of stresses on these reactions and help the individual to an understanding and an insight into his behavior. Plant Doctor of the Future Must Have Broad Understanding For this purpose, I would select a doctor with a warm personality and under standing who can sit down with the individual, canvass the whole environmental situ ation and help the individual, in a friendly but firm way, to recognize the true situation. Unfortunately, there are not too many of this kind of doctor at the moment and those available seem to have this capacity by endowment rather than by education. In environmental medicine we need to extend our activities and interests to the home. This may not always be feasible. It may even lead to widespread resentment because of the thought that the employer is getting too nosey. However, we must recognize that a lot of our problems are initiated and brought to full bloom in the family situation, although the employer bears the brunt of their manifestations. We need to assure ourselves that the truly sick person is kept off the job. We need to recognize that a person with a sick family or other severe home worries is. not a well person. It is not he, however, who is in need of treatment, but the FU LL- TIM E PART-TIM E "ON CA LL" Percentage of 3,589 PHYSICIANS IN INDUSTRY SM ALL Plants (Employing Less Than 500} 41% M EDIUM (Employing 500 to 1,000) 59% y. 29% LA RG E (Employing More Than 2,500} 62% 46% 42% *Vv* * , * ****** ,-(v Less Than Jl Hof 1% In a recen t survey by th e Nation al Association of M an ufacturers, more th an h alf th e 3,589 r e spon din g com pan ies reported in plan t m edical services. In th e ch art above, th e first section (left) shows th e percen tage of all respon din g com pan ies employin g full-tim e, part-tim e an d /or "on call" ph ysician s. (The percen tage reportin g no m edical services is n ot sh own.) Th e th ree sec tion s to th e righ t show th e percen tages for sm all, m edium an d large compan ies, Now the question naturally arises, where are we going to get doctors who have the knowledge and ability which industry needs? And get them in larger numbers as the need increases? Certainly, they should receive somewhere in their training an awareness of those large areas in which they will be of genuine service and still be real practicing physicians. Th is train in g, It seems to me, sh ould really come in th e un dergraduate courses at the medical schools. The un dergraduate sh ould be made aware of opportun ities in in dustry and of th e psychological or emotion al problems of in dividuals working or living in difficult circum stan ces. His future private patien ts will ben efit too. The student should know, too, something of the economics of private practice and of the tremendous strides which have been made in recent years in insurance coverage. Doctors in industry generally are not aware of the advantages of certain kinds of insurance -- disability, medical and surgical care and hospitalization in surance -- which, not infrequently, supplies part or all of the funds their patients pay for wider, more complete medical service than they have been able to afford in the past. They should make it a point to know and be able to explain to their patients the advantages of these insurance plans, the many benefits available and how properly to utilize them. There is one final qualification for the physicians who practice environmental medicine: warmth and understanding. Thq, personality -- or at least some evaluation of the emotional and psychological;adjustment of the student as a potential physi cian -- needs careful study in the selection of medical students. . > Sec. 34.65(e), P.L.& R. U. S. PO STAGE PAID New York, N . Y. Permit No. 2157 ROST A KEH OE MD COLL OF WHO I CI NE EDEN AVE CINCINNATI 19 OHIO :C V