The Benefits of Post-Job-Offer Medical Exams

Increasingly, employers are recognizing the benefits of incorporating a pre-placement examination into their employment process. A pre-placement examination provides employers with information that helps them to place employees in appropriate jobs.

How this came to be
In the past, prospective employees underwent a pre-employment exam, which was done before the person was hired. If the exam was not passed, then the applicant wasn’t hired.

With the passage of the Americans with Disabilities Act, pre-employment examinations became illegal. Hiring decisions couldn’t be made on the basis of physical limitations or disabilities.

The pre-employment exam was replaced by the pre-placement examination, also called the post-job-offer medical evaluation. This exam is performed after the offer of employment has been made. It’s designed to determine if the person can safely perform the job without putting himself or others at undue risk of injury. In addition, it’s designed to determine if the person will need accommodations to perform the job.

Why should I do pre-placement exams?
Most employers consider pre-placement exams a type of insurance. The vast majority of people sent for pre-placement exams are physically healthy and pass without problems.

However, a small number of people have medical problems that would interfere with their ability to safely perform their job. The exam should find them.

Establishing an examination program
Setting up an efficient and cost-effective program requires planning and thought. The examination should give you the information you need to make proper placement decisions, while still maintaining the examinee’s privacy and medical confidentiality. The exam must also be cost-efficient.

Finding the right doctor to perform your examinations is critical to the success of your program. You need a physician who fully understands the examiner’s role in the process. The doctor must realize that she is working primarily for you — the employer — and not for the person being examined.

The doctor’s job is to find any physical and medical problems that would interfere with the person’s ability to safely perform the job or significantly increase the risk of injury. Sometimes the problems are obvious; other times they’re very subtle.

The employer must provide the physician with information about the jobs and their physical demands. It’s imperative for the doctor you select to come to your workplace and see the physical demands of your positions. If the physician won’t do this, then it’s best to look for another doctor.

What information do you want?
What you’re really concerned about is whether the person can perform the tasks of the position. You have no need for, and really don’t want, all the details of the person’s medical history, a list of medications being taken, or the nitty-gritty details of the examination.

Actually, receiving detailed medical information might cause you problems. There are all sorts of rules and regulations concerning confidential medical information that you will have to follow. The information must be separated from other personnel information, and must be kept in a locked file with limited access. You can be liable if unauthorized people see the data.

All you really want is the doctor’s opinion on two questions. First, can this person safely perform the essential tasks of the job without putting himself or others at an increased risk of injury? Second, does this person need any special accommodations?

What should be checked?
It’s important that your examinations are comprehensive enough to find out what you need to know without going beyond that. Many employers include blood work, a urine analysis, an EKG, and other tests in their examinations.

But is there really a need for all this? In almost all cases, these tests aren’t necessary and won’t provide you with any useful information. For example, a person’s cholesterol level has no impact on his ability to perform a specific job safely. Even if elevated, it won’t affect the decision-making process. The same goes for other blood tests, urine tests, EKGs, X-rays, etc.

What should be in the physical examination process?
There are really six different components to the pre-placement examination process: the history, the examination, laboratory and imaging studies, special tests, the physical-capacity evaluation, and the summary letter from the physician. To have an effective and cost-efficient program, you must carefully consider each.

1. History

   
   

   A well-written history form is critical to the success of your pre-placement examination program. Many physicians consider the history — medical and occupational — to be the most important part of the entire process. Things that have happened before tend to happen again. For example, someone who has had back problems in the past is at an increased risk to have them again. A person with a history of respiratory problems is likely to have them again, particularly if exposed to respiratory irritants.

   
   

   In addition to the general questions, the history should be customized to address the special circumstances of your company. Respiratory exposures, hazardous materials, or carcinogens, for example, and their consequences must be included in the history.

   
   

   Having a comprehensive history form is useless if it’s not completed accurately by the examinee and carefully reviewed by the examiner. One way to know if the doctor looked at the form is to see if she commented on any of the positive answers.

2. The examination

   
   

   The goal of the physical examination portion of the process is to detect problems that might interfere with the examinee’s ability to safely perform the essential tasks of his job without putting himself or others at undue risk of injury and without significant accommodations.

   
   

   Most examiners follow the same steps for all pre-placement examinations. Special attention should be paid to the examinee’s movements, muscular strength, coordination, and overall physical condition. While listening to the heart and lungs is important, it rarely adds much to the final determination of fitness for duty.

   
   

   It’s important for the examiner to know the requirements of the job, particularly if there are any special physical demands. In many ways, the examination itself is the least significant part of the process.

3. Laboratory and imaging studies

   
   

   In most cases, you won’t need any blood or urine tests. The exception is if the position requires biological monitoring. If the position poses a risk of lead exposure, then you’ll need baseline studies: a lead level, a zinc protophorphyrin, and a complete blood count looking for anemia. Other exposures require different base studies. Other than baseline studies, there’s really little reason to order any blood work.

   
   

   In the past, many companies ordered back X-rays, hoping to find potential back problems before they occurred. This has been proven to be a total waste of money. There’s absolutely no correlation between what’s seen on back X-rays and the likelihood of sustaining a back injury. As with lab tests, the only reason to order any X-rays is to obtain a baseline for screening programs.

4. Special tests

   
   

   In this category, I put audiograms, pulmonary function tests, specialized vision testing, etc. In most cases, these studies are required as part of a company’s monitoring and surveillance programs. If your workplace noise levels exceed the safe levels, then you’ll need a hearing-conservation program. A baseline audiogram is then essential.

5. The physical-capacity evaluation

   
   

   A physical-capacity evaluation is designed to determine whether the examinee is physically able to perform all the tasks of the job. For example, if the job requires lifting 25 pounds and carrying it for 20 feet, the evaluation would include lifting 25 pounds and carrying it 20 feet. Not all tasks are as easy to simulate.

   
   

   Frequently, these evaluations are performed by a physical therapist or a PT aide. Many believe that this is a more valuable form of screening than a physical examination.

6. The summary letter

   
   

   Once the history is reviewed, the examination is completed, the results of all studies — if any — are back, and the physical-capacity evaluation is completed, then the physician must pull all this data together and give an opinion on the examinee’s physical fitness. The doctor can tell you if the examinee has any physical limitations or requires any special accommodations. It is not the physician’s role to tell you whether to put this person to work or not. That’s totally up to you.

   
   

   Most employers want only the summary letter and not copies of the history, examination report, and most of the lab and imaging studies. You don’t need that data and, as explained above, it can increase your liability risks.

Summary
A well-designed pre-placement physical examination program will result in fewer injuries and accidents and, in the long run, save your company money.

The information contained in this article is intended to provide useful information on the topic covered, but should not be construed as legal advice or a legal opinion. Also remember that state laws may differ from federal law.