It has been about three weeks since I’ve had my favorite tortilla. The plant that makes them, located on the lower west side of Chicago, closed after one of its workers died of COVID-19. Unlike workers in the meat-packing industry, the employees of this particular tortilla plant were not forced to go back to work. Instead, the factory closed to perform a thorough cleaning and new construction. Since the outbreak of COVID-19, the media has discussed in depth the impact that the pandemic has had on the health and wellbeing of workers, primarily first responders and those involved in health care. However, the pandemic has also brought to light the dependence that society has on workers who provide other services we now realize are also essential. Unfortunately, these essential workers, especially those working in the grocery, transportation, delivery industries, as well as meat-packing industries, just to name a few, are also at a much higher risk of being infected with COVID-19 than the general public. While public recognition and appreciation keep growing for the services that these essential workers provide, measures to reduce their risk of infection, or to provide adequate salaries and health insurance, including worker’s compensation, are often lacking. Taking all of this into consideration, this underscores the need for us as physicians to speak with patients about the conditions of their employment. A patient’s working conditions—or lack of employment altogether—often explain many medical symptoms, such as pain, burnout, depression, poor nutrition, exhaustion, and substance abuse. In fact, a May 2019 report by the World Health Organization included burnout as “an occupational phenomenon.” Current research on working environments has pointed out multiple factors that may promote COVID transmission, including elevated noise levels that force workers to speak loudly and thereby generate more aerosols, ergonomic conditions that lead to unavoidable unsafe distancing, and even ambient indoor heat and humidity that may serve as hothouses for superspreading events. Preventing illness and injury out of the conditions of employment falls within the scope of occupational and environmental medicine, a long-established but virtually unrecognized health specialty. Importantly, it is also an understaffed specialty, and the problem is only getting worse. For example, due to a lack of funding, medical residency training in this specialty has been declining for the last three decades. As a consequence, residents training in internal medicine don’t have enough opportunities to rotate through these clinics. As a clinical educator in primary care clinics, I found that teaching residents to inquire about a patient’s job and employment conditions was essential, not only to provide appropriate care but also to prevent medical complications and future injuries of their patients. Also, rotating residents through Occupational Medicine clinics, if available, will enhance their skills and broaden and deepen the scope of their ability to care for patients. People with full-time jobs spend an average of 35 percent of the day working as well close to a quarter of their weekends. This impacts the management of the most common chronic medical problems in the population. Therefore, including conversations about jobs during the clinical interview is very important. Questions for patients should include asking about hours spent sitting, standing, or performing repetitive moments, information that can help in the diagnosis and future prevention of musculoskeletal complaints. Doctors should explore the use of protective equipment intended to prevent exposure to fumes or toxic liquids in order to aid in the diagnosis of respiratory and skin problems. Discussing working shifts and time assigned for meals might help the patient to arrange appropriate times to take medication to prevent medical complications, such as hypoglycemia in a diabetic patient. Providing creative tools for the patient to develop cultural, appealing, and affordable strategies to adopt healthy diets like DASH during working hours would help to improve such issues as high blood pressure and obesity. When appropriate, physicians should write letters requesting special accommodations for the patient’s medical needs during work hours, or requesting a change in the patient’s job description. We are currently in the midst of a public health crisis with devastating consequences on the lives of many patients across the nation, especially the most vulnerable, including the special workers. It has exposed the impact of environmental and working conditions in the population that are not new. Physicians need to speak with their patients about their working conditions, including those at risk of infection, those currently working from home, and those who are unemployed, even more relevant now than ever. The occupational and environmental specialty should be recognized as being essential for the wellbeing of patients and receive the funding needed to increase the numbers of doctors in training. By doing so, the health and wellbeing of not only essential workers but all workers could be vastly improved. Irene Martinez is an internal medicine physician. Source
