The Injured Worker and the Internist

The Injured Worker and the Internist

Nortin M. Hadler

University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7280. Requests for Reprints: Nortin M. Hadler, MD, Department of Medicine, University of North Carolina School of Medicine, 932 Faculty Laboratory Office Building 231H, Chapel Hill, NC 27599-7280.

“How're the kids?” “How's your wife?” “How's Joe?” “How's school?” “Are you still bowling?”

Idle talk? Hardly. To establish rapport? Not just.

As internal medicine sheds 40 years of scientific reductionism, these questions are emerging as requisite in the clinical interview. We watch our patient's eyes and body language. We pursue any inkling of difficulty. After all, we are probing for the symptoms of some of the most life-threatening, and potentially remedial, diseases in our society: abusive relationships, self-destructive behavior, and affective disorders. Physicians are finally confronting this plague.

“How's work?”

This question needs to carry the same importance as those above. Gainful employment is one path to self-respect and some degree of autonomy in our society. But the path is never smooth, seldom easy, and occasionally dangerous. It is time for internists to deal with the pathogenetic potential of the contemporary workplace.

Traumatic Injury

Sprains, lacerations, burns, amputations, fractures, fatal falls … The incidence of physical and thermal injuries varies from industry to industry and from place to place, but nowhere is it insignificant. Every injury is a reproach to our national ethic. No safety device should ever be breached. No lesson in carefulness squelched. That holds for the financially strapped small shop or farm as well as for the large employer. The clinical interview can include inquiries into safety practices. We can urge our patients to call for an investigation by the Occupational Safety and Health Administration of perceived abuses; their confidentiality is assured. Physical hazards should become a horror of the past. An insightful, proactive physician can help every worker at risk to understand the available recourse [1].