Document KJr5kdrV1X934pD2j7y2Nyrvw

"1 Allentown. P6NNSYlvah/a tstos 28 December 1978 Lloyd B. Topper, M.D. Corporate) Medical director Barkley Beidleman.M.D. The Medical Center Clinic 8333 North Davis Highway Pensacola, FIorid.a 32504' Dear Bark: Your letter of December 11th just arrived.- (I see' now, that it's postmarked December 20th.) First about the chest films: I suspect that every scheme is arbitrary. One rarely sees bronchlogenic carcinprna in persons under 4-0, but when one does the disease is surely worth finding. My feeling,Is that the best scheme reflects age, occupation, smoking habits, history, and-/ convenience of the procedure. Of these factors, smoking is probably the most important, and I would have no reservation in obtaining an-annual film on all smokers. So doing probably has an educational impact on the smoker as well. Frankly I'm not sure whatTis',likely to ' be found in asymptomatic non-smokers under 40 or 45, What has been your specific experience that leads you to conclude that "everybody ought to have an annual chest x-ray regardless of age..."? The radiologists with whom I deal don't appear to subscribe to this. Your second question about employment standards reflects concern about an area In which the rules are rapidly changing. One thing that can be said flat-out is that an employer cannot reject an applicant solely to protect against the likelihood of insurance claims. Your man with a cardiac defect, who presumably can handle the job, could sue successfully if he was barred from employment only because it would be likely that we would have to pay for diagnostic studies, surgery, lost time, etc. As I soo it. (on 17/27/78), wr ought: not tn hiro: 1. People who have an existing condition that would be aggravated by the intended job. Examples: Lifting & disc disease; diabetes & rotating shifts or irregular travel requirements; iiver disease & chlorinated hydrocarbon exposure. Hypertension & "stress" is a gray area. AP00030631 cria*d Ci4*niea& Barkley Beidleman, M.D. Continued.... Page Two 28 December 1978 2. People who have a condition which invalidates tests used to detect occupational intoxication. Examples: Abnormal liver function tests in VCH workers; sarcoidosis in beryllium workers. 3. People who have a condition which would place fellow workers, customers, or the public in jeopardy. Examples: Communicable disease; ASHD in truck drivers, pilots, crane operators, armed guards, etc; seizure disorders in these occupations. 4. People who cannot do the job. Examples: Color-blind instrument electricians; warehousemen with orthopedic problems. If your man with the inter-atrial septal defect can do the job and not be injured by it nor put others at risk, he's employable. We pick up the insurance tab. At some point the regulators who plan our lives determined that it is of greater social value to see that this man is employed than-to. preserve the traditlonal -prerogati ves of the employer. No, it will not. be Tahiti, but the medical get-together is long over-due. I'd like to get the Calvert City situation worked out first, viz., who is doing what. Best wishes for the New Year, LBT:1pf 116yd B>: Tepper, M.D. 1 i AP00030632 I