Occupational and Environmental History

The primary step in the occupational/environmental history involves a survey of all patients. The survey covers all important questions and focuses on the chief complaint (or diagnosis) to find clues that would indicate a relationship to work or home based activities. Questions can include a list of all existing and longest held employment, a short description of current job, and inquiries regarding changes or concerns related to hazardous exposures at home or at work.

In order to make temporal relationship work, it is better to begin with questions that are non-suggestive, for instance, “Does your symptom improve or worsen at work or at home? Work days or weekends?” instead of more suggestive questions, for instance, “Do you feel sick due to work?” Any indication that the symptoms may be associated with past or recent exposures, or due to specific changes in the environment, either at home or at work, then prompts a more detailed sequence of questions in order to gather additional information about possible exposures and timing of environment or work related symptoms.

In specific cases, the screening occupational environment survey has shown temporal relationships, indicative of the role of work/environmental factors: the painter who was removing old paint developing symptoms such as abdominal pain (lead poisoning?); symptoms such as itching in the hand and a rash experienced by the lab technician every time he puts on the latex gloves (allergy?); the father and other members of the family who experience headaches in the fall which are worse at home, especially in the morning (carbon monoxide poisoning caused by a faulty furnace?).

Certain cases of acute poisoning have presented themselves with fast onset of characteristic signs and symptoms (“toxidromes”), arising from deliberate or accidental release of toxins that necessitate prompt identification and treatment, very often prior to obtaining diagnostic laboratory tests of the poison. For instance, symptoms such as dim vision, miosis, rhinorrhea, eye pain, diarrhea, sweating and headache can indicate strongly towards an overdose of cholinesterase inhibitor, for example sarin serve gas or an organophosphate pesticide. In the toxic nerve gas attack in Tokyo’s subway system, perpetrated by a religious cult, 11 individuals died and around 5000 people required emergency treatment.