Will occupational physicians ever be recognised as consultants?

It has been a long time coming but it is gratifying to see public health doctors being recognised as consultants. This relatively small band of physicians have worked long hours and under considerable stress over the past nine months to save Irish citizens from even greater harm from Covid-19.

Without their expertise, the fundamental structures we need to safeguard public health in the face of the worst infectious diseases pandemic since 1968, would simply not exist. Last week's announcement by Minister for Health Stephen Donnelly is most welcome.

There is another group of specialist doctors who have filled a “Cinderella” role in the Irish health system for far too long. They are occupational health specialists (full disclosure: I am one of these doctors).

Whether individuals can remain at work requires some
highly skilled and nuanced risk assessments by occupational health physicians

Without these physicians and their occupational nurse colleagues, it is almost certain the health service would have collapsed under pressure of Covid-19. How? Because, as the virus sweeps through the population in waves, it poses a particular risk to frontline health workers. Those who test positive for Sars-CoV-2 or become close contacts of a case have to be removed from work as they pose a danger to patients. Sometimes entire teams of doctors, nurses and allied health professionals have had to leave work for up to 14 days in order not to spread the infectious disease.

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Then there are healthcare workers with their own pre-existing health problems. Many people are now on treatment with so-called biologicals – disease-modifying injections that have transformed the lives of people with rheumatoid arthritis and other serious conditions. One of their potential side effects is to leave some people prone to infectious disease. Whether individuals can remain at work requires some highly skilled and nuanced risk assessments by occupational health physicians.

The same process applies to patients with chronic heart and lung diseases, as well as people with diabetes. Each requires a detailed individual health assessment by an occupational medicine specialist in order to establish whether it is safe for them to work while Covid-19 circulates.

But the need for occupational health consultants goes beyond the health service. Outbreaks of Covid-19 in meat plants have required careful management by public health and occupational health experts. We are fortunate in the Republic to have one subspecialist in this area, occupational physician Dr Deirdre Gleeson, whose input has been invaluable in helping to mount an effective national response to Covid-19 in the meat industry.

Occupational medicine has it roots back in the 18th century, when Bernardino Ramazzini, an Italian doctor who specialised in workers' health problems, put the discipline on a firm footing.

He was the author of a detailed textbook of occupational medicine, De Morbis Artificum Diatriba [Diseases of Workers]. Ramazzini was a proponent of prevention being better than cure. Now occupational medicine specialists will advise removing the workplace hazard as a first step, thereby preventing disease. Asbestos is a classic example of this; its use now banned in construction because of the high risk of lung cancer and asbestosis in those exposed to asbestos fibres.

Although occupational physicians undergo a similar length of specialist training as other health service consultants, they have never been accorded consultant status, as their international colleagues have been. Why, remains a mystery. After all, they provide expert advice to patients, they are responsible for multidisciplinary teams in the same way as a consultant surgeon or a consultant psychiatrist, they must be enrolled on the Medical Council specialist register, and are recognised as experts by the courts.

With public health physicians about to lose their "Cinderella" status, how long before occupational physicians are recognised as consultants? They have a strong case and their vital role has been recognised in the HSE's €600 million winter plan, with welcome funding for additional posts announced by chief executive Paul Reid.

Stephen Donnelly, how about a Yes, Minister?

[ mhouston@irishtimes.com ]