ACU supports clinicians and improving health care for the underserved by raising the quality of care, expanding access to care, and developing culturally competent and adequately resourced health care workforce.
A clinician is a health care professional typically employed at a skilled nursing facility or clinic. Clinicians work directly with patients rather than in a laboratory or as a researcher. A clinician may diagnose, treat, and otherwise care for patients. For example, psychologists, clinical pharmacists, clinical scientists, nurses, physiotherapists, dentists, optometrists, physician assistants and physicians can be considered clinicians. Many clinicians take comprehensive exams to be licensed and some complete graduate degrees (master's or doctorates) in their field of expertise.
Physicians, nurses, nurse practitioners, physician assistants and other health care professionals often encounter work-related health and safety questions as they care for their patients. This web page provides information, resources and links to help clinicians navigate OSHA's web site and aid clinicians in caring for workers.
For clinicians establishing or working in an occupational health practice, many protocols and procedures will depend on the practice situation (i.e. freestanding clinic, corporate clinic, large clinic network) and on the industry or industries being served. However, the following are important considerations for any clinician providing occupational health services:
Confidentiality is a key ethical principle and arises in many aspects of occupational health practice. ACOEM's Position Statement on Confidentiality of Medical Information in the Workplace provides guidance to clinicians on this important issue.
The occupational and environmental exposure history is the most important tool that clinicians have when evaluating a worker for a work-related injury or illness. Clinician knowledge of a worker's occupational history and job duties are vital when performing fitness for duty and medical surveillance examinations. Clinicians should take the time necessary to understand a worker's job duties, work environment and exposures.
When evaluating an injury, clinicians should take a detailed history from the worker to determine the mechanism(s) of injury and record the specific work tasks and ergonomic factors that may play a part in the injury. Important factors include number of hours worked per day, overtime, recent changes in job tasks or processes, tools used, environmental factors (such as temperature), previous work injuries, and exposures to chemical and biological hazards. Cultural factors within the workplace and the worker including his or her primary language should be recorded. A good resource is ATSDR's "Taking an Exposure History" which includes discussion and case studies of taking an occupational and environmental exposure history.
Clinicians in occupational settings should familiarize themselves with the first aid procedures outlined in the SDS, be aware of the nature of the training being delivered to workers, and participate in the training if needed to explain adverse health effects or first aid procedures. Exposure information listed on SDS's is helpful in considering workplace screening and surveillance programs. When evaluating exposed workers, clinicians have the right not only to request SDS's from manufacturers and employers but also to obtain proprietary ingredients not listed on the SDS due to trade secrets protection.
According to HIPAA, employers have access to some protected health information if the disclosure is required to comply with laws relating to workers' compensation. HIPAA also allows disclosure per the requirements of state or federal laws and regulations. Thus, clinicians should be mindful of confidentiality when recording patient information in occupational medical records. Occupational health clinicians regularly keep personal health information (i.e. medical conditions not related to work) separate from exposure records. Certain OSHA standards require employers to obtain written opinions from clinicians performing required medical surveillance examinations. These standards typically state that "the employer shall instruct the physician not to reveal in the written opinion specific findings or diagnoses unrelated to occupational exposure."
While workers' compensation and OSHA are distinct, the following is important information for clinicians working in the field of occupational health, particularly those new to the field. Because each jurisdiction is different, clinicians should be aware of local policies and procedures. A list of state and federal agencies and their websites is available. In addition, workers' compensation for federal employees is provided under the Department of Labor, Office of Workers' Compensation Programs (OWCP), which includes programs for longshore and harbor workers, nuclear energy workers, and coal miners.
For confidentiality purposes, clinicians should be very careful to avoid recording non-work-related medical information in the workers compensation medical records. Workers compensation medical records should be kept separate from personal medical records.
The Agency for Toxic Substances and Disease Registry (ATSDR) is a federal agency under the Department of Health and Human Services focusing on environmental health concerns and toxicology. ATSDR is mandated to assess waste sites, provide public health consultations concerning specific hazardous substances, perform health surveillance, maintain registries, perform research on environmental health issues, develop and disseminate information to the public on hazardous substances, and do education and training on environmental health. ATSDR has a wealth of information on-line concerning the toxicology and health effects of many hazardous substances. Of particular interest to clinicians are:
The Association of Occupational and Environmental Clinics (AOEC) is a national network of clinics specializing in occupational and environmental clinical evaluation. Over 60 clinics, including many with ties to university teaching centers, are members. Some clinics also have specialized pediatric environmental units. AOEC also has a wide range of educational and guidance materials for clinicians.
The Migrant Clinicians Network (MCN) is a national, not-for-profit organization founded by clinicians working in migrant health. Over 1,000 clinics across the country are members of the network. MCN provides a wealth of information for clinicians and migrant workers.
The American College of Occupational and Environmental Medicine (ACOEM) is the professional organization for physicians specializing in occupational medicine. ACOEM has a number of resources for occupational health clinicians, including continuing education courses and conferences, clinical practice guidelines, position statements and publications.
This module builds off the Foundations of LGBTQIA+ Health Part 1 by offering specific information for clinicians, including: effective communication with LGBTQIA+ patients, asking about sexual orientation and gender identity, and addressing health disparities through clinical care.
Building on two decades of collaboration between the UNC schools of medicine and public health, this concentration offers an opportunity for medical students, physicians, and other clinicians to gain mastery in public health and population science. It also offers a unique interdisciplinary focus on clinical, prevention, population and social sciences.
To collect data, a five-point Likert-scale questionnaire (see Appendix) was designed on the basis of the literature review. The scale ranged from very high (5) to very low (1). The questionnaire consisted of seven parts. Part 1 included personal information (eight questions), part 2 was related to the clinicians' knowledge of telemedicine technology (seven questions), and part 3 investigated clinicians' perception of the advantages of telemedicine technology (seven questions). Parts 4 to 7 asked about clinicians' perception of the disadvantages of telemedicine technology (eight questions), the necessity of deploying telemedicine technology (six questions), the impact of the application's ease of use (six questions), and the importance of the security of telemedicine technology (six questions).
The findings showed that the knowledge of a majority of clinicians (96.1 percent) about telemedicine technology was at a low or very low level (1.75 0.51). They believed that continuous training in the use of telemedicine would be the most efficient solution to increase their knowledge about telemedicine (3.88 0.68). Among clinicians, pharmacists' knowledge of the application of telemedicine technology (2.0 0.81) was more than that of other groups of clinicians, and the knowledge of dentists (1.14 0.37) was lower than that of others.
The clinicians' perception of the advantages of using telemedicine technology was at a moderate level (3.07 0.72). In this part of the questionnaire, the highest mean value was related to the reduction of unnecessary transportation costs (3.94 0.79) and the lowest mean value (1.82 1.04) was related to the overall familiarity of clinicians with the advantages of telemedicine. Regarding the reduction of unnecessary transportation costs, the nurses had the highest mean value (4.02 0.72), and the pharmacists and dentists had the lowest mean value (3.42 0.97). A comparison of the clinicians' views about the advantages of telemedicine technology is presented in Figure 2.
According to the results, more than half of the clinicians (n = 140, 68.0 percent) thought that the disadvantages of telemedicine technology were at a low or very low level (2.31 0.47). The highest mean value (3.14 0.73) was related to increased malpractice because of the use of telemedicine technology, and the lowest mean value (1.85 0.86) was related to the psychological impact on patients. Regarding the increased malpractice, the dentists had the highest mean value (3.28 0.48), and the pathologists had the lowest mean value (2.50 0.70). 041b061a72