Fitness for work in difficult cases: An occupational medicine experience in a University Hospital

Background: Fitness for work (FW) in certain clinical cases poses significant professional challenges for Occupational Physicians (OPs). Objectives: to discuss the role of a public Institute of Occupational Medicine (IOM) in FW, thorough description of clinical cases. Methods: the IOM at the University of Brescia is a public clinic available to general practitioners, OPs, other specialists, insurance companies, health authorities, employers, trade unions. IOM expert opinion on FW may be requested by OPs, employers or workers. In each case, occupational and clinical histories are taken, physical examinations, laboratory and instrumental tests might be performed, and technical and clinical documentation is acquired; expert opinions from other specialists might also be sought. Risk assessment (RA) stems from worksite inspections and information from company health and safety representatives, or health authorities. Results: a few peculiar clinical cases are reported: tremors in a dental hygienist trainee, chorioretinitis in a welder, spasmofilia in a nursing aide, obstructive sleep apnoea in a steel worker, epilepsy in a metal engineering worker, as well as a number of cases from the same workplace. Conclusions: FWjudgement made by a IOM had several advantages from clinical and RA aspects. Work restrictions may not always be evidence based and it might be difficult to balance rights and duties of patients, employers and OPs; the IOM's wider experience, case discussion with the relevant parties, scientific and technical documentation of diagnostic and FWprocesses, strengthen the role of the IOM in dealing with difficult cases and as a guarantee from technical and ethical viewpoints.