The role of the occupational physician in primary health care

To standardize the concepts and definitions discussed in this work, it is important to explain the meaning of primary health care (PHC). This term was first defined by the World Health Organization (WHO) in 1978 in a document known as the Declaration of Alma-Ata1:

Primary health care is essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.

The WHO definition of PHC also describes it as the first point of contact between patients and the health care system, which is responsible for bringing health care as close as possible to the places where people live and work. This definition already describes part of the role of occupational physicians, and draws a strong connection to occupational medicine, since occupational physicians often represent the first, and perhaps only, contact between workers and the health care system.

Since one of the goals of PHC is to disseminate recommendations on disease prevention and health promotion, occupational medical examinations can (and should) be used as a “bridge” to general health care for workers.

RELATIONSHIP BETWEEN PHC AND HEALTH PROMOTION

The first international conference on Health Promotion, held in Canada in 1986, established guidelines and concepts and reinforced the comprehensive view of health, which holds that health should be viewed as a precious resource for daily life rather than the objective of living.2 This approach to health views it as a positive concept and emphasizes its association with the personal and social resources of the individual so that health promotion is no longer the sole responsibility of health professionals. Each individual is encouraged to think and act so as to increases their control over their health.

Health promotion is based on two pillars: everyday behavior and the circumstances under which we live. Both have a major impact on life and health; that is, health is strongly influenced by both factors. Health promotion offers a holistic approach and a comprehensive view of the individual, since being healthy is much more than not being ill.3 The four basic attributes listed below must be part of the role of occupational physicians in PHC:

1. ATTENTION TO THE FIRST POINT OF CONTACT

The first point of contact occurs in admission examinations, in which occupational physicians should be seen by workers as accessible, interested, and reliable so that the medical examination goes beyond an assessment of fitness and conducts a holistic evaluation of the worker. This is when the physician-worker relationship begins.

2. CONTINUITY OF CARE

Frequent periodical examinations are a form of regular care and longitudinal assistance. Occupational physicians and workers must be aware that these examinations are more than just a regulatory artifact, and involve an ongoing assessment of the worker’s health status. This contributes to the establishment of a bond between the patient and physician, allowing these professionals to become familiar with patients’ medical history, which will ultimately help them understand any issues that arise in the future. This bond must be converted into mutual cooperation.

3. COMPREHENSIVE SERVICE

Comprehensive occupational medicine, whether public/private/outsourced, includes occupational and clinical care so that the patient can be referred to other health care services, such as consultations with specialists or hospitalization if an illness occurs. This comprehensive approach also means expanding the concept of health to include psychosocial factors.

4. COORDINATION (INTEGRATION) OF CARE

The occupational physician must organize, coordinate, and integrate the actions of previously mentioned services. Care coordination ensures continuity in the services provided by different professionals, outsourced or otherwise. Physicians must ensure that the problems observed in previous appointments or causes for referral are continuously evaluated. This is easier when the same professional continues to care for the worker or has access to medical records containing information on all previous appointments.

Occupational physicians must have a priori knowledge of general clinical topics to carry out their role in the world of work. The worker must be seen, assisted, and understood as a whole being rather than segmented into occupational and non-occupational sections, creating a stochastic process that allows the occupational physician to become familiar with the worker’s past (medical records), predict their future (health promotion) and, as a result, contribute to their present state (prevention). This expanded, holistic, and non-utopian perspective of the role of occupational physicians will maximize its benefits to employees, employers, the health care system, and, especially, the Brazilian nation as a whole.