Prof. dr Ljiljana Cvejanov-Kezunović

University of Montenegro, Medical faculty Podgorica

Why hollistic approach is so important?

We need comprehensive approach to the patient

Patient has to be subject, not object of our action

Circumstances in which people live and work

Dynamic changes in the environment

Multimorbidity

Multicausality of health disorders

What we expect from our students/residents?

To become a good primary care practitioners?

To recognize diseases?

To solve problems of the most common cases?

To be experts for special topics?

To be good professionals?

To protect patients from diseases?

To protect patients from medicalization and

from overly specialized medical approach?

WHO approach to workers health

Health at work Workers health

Health at work

Employed workers

Employers responsibility

Only at workplace

Only work-related health

problems

Contracting between employers

and workers

Workers health

All workers

All stakeholders are responsible

Holistic approach

All health determinants

Health protection is not subject

only of the collective contract; it is

a public problem

Example

44 year-old track driver

His company is in decline, bankruptcy is looming. He was recently treated at the cardiology clinic because of AMI. He comes to his GP asking:

1. Do I have to be on sick-leave?

2. When can I return to work?

3. Did I get a heart attack because of work?

4. If so, can you note that my AMI was a work-related accident (to get a 100% salary)?

Personal doctors and workers’ health

Only 10-15% of workers have access to OH services;

The issues of workers’ health and work ability assessment are included in every day work;

GPs have public authority to manage sick leave in many countries;

They have difficulties in providing advice related to the job because of the short time of the visits;

Gunnyeon B, Parker G, Sharp C et al. The health and workhandbook: patient care and occupational health: a partnership guide for primary care and occupational health teams. Faculty Occup Med 2005; 1–3.

Morrison J. The role of the GP in keeping people in work. Occup Med (Lond) 2011;61:74–75. Verbeek J, Madan I. From sick notes to fit notes. Br Med J 2009;339:587–588.

Vulnerable groups of workers adrressed

to primary care

workers in small and middle-sized enterprizes and in informal economy,

self-employed,

migrants,

people with disability or chronic medical conditions,

others

So, the relevant question is: „Can Primary Care, covering 70-80% of global population, offer adequate interventions to meet specific workers’ health needs?“

The ten biggest health risks in Europe

0 2 4 6 8 10 12 14 16 18 20

Illicit drugs

Occupational risks

Environmental risks

Physical inactivity

Low fruit and vegetable intake

Overweight

Cholesterol

Alcohol

Tobacco

Blood pressure

DALYs %

SEE Subregion The Bucharest Statement

Adopted by the 9th Meeting of the WHO SEENWH, Bucharest, Romania 13-14 July 2012.

Montenegrin task :

Development of human resources for OH services

by making use and upgrading the competences and

capacities of the existing resources

particularly in occupational medicine and

by training the other professional groups

for multidisciplinary expertise

Montenegrin homework

Development of training programmes in OH

for different target groups:

1. Medical students,

2. Nurses,

3. OH specialists and

4. Family doctors

GRADUATE PROGRAM FOR MEDICAL STUDENTS

VII & VIII SEMESTER

Subject lectures & seminars training total

Neurology 2

WA in neurological disorders

Epilepsy and work

1

Clinical

cases

3

Dermatology 2

WA in dermatological diseases

Professional dermatoses

1

Clinical

cases

3

Internal

medicine

4

Work related diseases. WA in

cardiological, pulmological patients,

COPD and asthma related to work

Pneumoconioses

2

Clinical

cases

6

GRADUATE PROGRAM FOR MEDICAL STUDENTS

IX& X SEMESTER

Subject lectures & seminars training total

Psychiatry 2

WA and mental health

Stress at work, burnout, mobing,

technostress

1

Clinical

cases

3

Surgery 4

Professional traumatism, work disability in

surgical patients

2

Sick leave

at injury at

work

6

Pediatrics 2

Professional orientation

1

Examples

3

Gynecology 2

Women’s health and work, pregnancy and

work

1

Clinical

cases

3

GRADUATE PROGRAM FOR MEDICAL STUDENTS

XI SEMESTER

Subject lectures & seminars training total

ENT (ORL) 2

Professional hearing loss

1

Clinical

cases

3

Ophthalmology 2

Visual function and work

1

Clinical

cases

3

Environmental and

Occupational

Medicine

19

11 30

Total 41 22 63

THE AIM OF OCCUPATIONAL MEDICINE SUBJECT

the principles of health and safety at work,

special health promotion and prevention of

illnesses and injuries at work,

work related hazards and their health effects,

professional diseases,

injuries at work,

work related diseases, and

basic criteria of temporary and permanent

work ability assessment

ADDITIONAL KNOWLEDGE AND TRAINING SKILLS

REFERS TO:

Injuries at work, including acute intoxications (physical, chemical, biological factors, psycho-social reasons, etc.)

Workers’ injuries not connected directly to work, consequences of traffic accident, violence, sports and reacreative activities, and cosequences to work ability,

Violence at work,

High risk workplaces,

Vulnerable groups, high exposure to hazards (Roma, blue collar workers, workers with chronical diseases such as epilepsy, diabetes, IBS, etc.)

Mobing victims and suicide

Other violences (family, teenage, sport fans, etc.)

How to rehabilitate and reintegrate injured persons into their communities and workplaces.

GRADUATE PROGRAMME. FAMILY MEDICINE SUBJECT

VIII, X and XI semester

Preparing students for work in primary

care

Special competecies

Workers as a large population group

with a many specificities

GRADUATE PROGRAM FOR COLLEGE LEVEL NURSES

Lectures and training skills:

Health and safety at work

Risks at workplace and workers’ health

Environmental monitoring at HCW workplace

Profesional diseases (recognition, registration, prevention, treatment, etc.)

HCW and biological risks, protection

HCW and radiation, ionizing and adverse effects

HCW and cytostatic drugs, protection

HCW and hhemical agents

Nurses and preventive measures at workplace

FAMILY MEDICINE RESIDENCY PROGRAM courses:

Lectures (11): Small Group Workshops (12):

Workers health, primary care approach Taking an occupational history at FM office

Risk assessment at workplace Work analysis, assessment, and workplace evaluation

(HCW)

Work related diseases Discussion about HCW, conclusions

Preventive check-ups and WAA How to plan and perform preventive check-up for w.?

Temporary disability Sick leave: experiences from everyday practice.

Collaboration with other specialists and comissions

Injuries at work Injury at work Report Form. E-learning cabinet training

Professional diseases. Recognition and

registration. FM role.

Register of occupational diseases form. E-learning

cabinet training

Referal to disability – pension

committee

Referal to disability – pension comittee

WAA in patients with cardiovascular Discussion. Examples from our practice

WAA in patients with respiratory

diseases

Functional diagnostic procedures and monitoring

patients with asthma and COPD

Thank you!