Pre-employment medical examination: an update

Abstract

Background: It is generally believed that pre-employment medical examination (PEME) allows strictly for the Physician's evaluation of the capacity of a prospective employee to assume duty and be able to function without risk to self or others. In practice this scope is usually exceeded as employees are subjected to a set of routine examination and procedures which have no bearing on the nature of the occupation being assumed.

Objective: To review the conduct of PEME, its evidence base, its perceived benefits and the ethical issues involved.

Methods: The databases of PubMed, EMBASE and Google scholar were searched for review articles and Guidelines on PEME using the Mesh terms “pre-employment medical examination”, “Preplacement examination”, “Medical fitness” and“ Fit-to-work”.

Results: Little empiric evidence has been advanced in support of PEME relative to health and economic outcomes. As a screening examination, PEME has not been found to show any significant benefits on employee longevity, rate of absenteeism and utilization of health care resources. The methods of carrying out of PEME should be determined by the job description and for most white collar jobs a focused clinical interview using standardized questionnaire suffices. Although the usual patient doctor relationship may not exist in PEME, it is nonetheless a medical encounter of significance and should be guided by the code of ethics.

Conclusion: The content and scope of PEME should be guided by the job description. Many of the presumed benefits of PEME lack sufficient scientific basis and for this reason Physicians should advice against subjecting employees to unnecessary investigations.

Keywords: Pre-employment examination, Preplacement examination, Fit-to-work, Medical fitness, Occupational Medicine