Occupational and environmental exposure

The recent article by Lynn Marshall and colleagues1 addresses an important issue: occupational and environmental exposures that may have a causal relation to symptoms and illness. However, the example of a photocopier in the sample case is unfortunate.

From the information provided, it is not clear that the photocopier is causing the symptoms. Regardless, some might argue that moving the photocopier is a request that could be easily accommodated. But what if this small business has no other location for it? If the patient's physician suggested the photocopier is making her ill, she is likely to believe it. Should she leave the workplace? Who is responsible for her lost wages if she leaves?

This is not to suggest that no cases require physician action. Those that do are established clinical entities: asthma, contact dermatitis and toxicities where exposures, dose responses, symptoms, signs and mechanisms are well understood. And there are other cases, sentinel events, where a more direct causality is demonstrable, and the physician may need to notify the employee, workplace and public agencies.

In all cases, a treating physician's advice should be based on an established scientific body of knowledge.

Michael Schweigert Occupational Health Services Program St. Michael's Hospital Toronto, Ont.