RECENTLY OCCUPATIONAL HEALTH TEXTS have appeared every 2 to 3 years. Environmental and Occupational Medicine, third edition, appeared in 1998(1) followed by Hunter‘s Diseases of Occupations, ninth edition, in 2000.2 The pattern continues with A Practical Approach to Occupational and Environmental Medicine, the third edition of another established text, edited by Robert J. McCunney. These textbooks define the specialty of occupational and environmental medicine, although for the busy clinician or inquisitive administrator, they merge into the genre of periodically updated occupational medicine text. The feature distinguishing McCunney‘s text from the rest is its distinctly clinical approach.
The second edition of A Practical Approach to Occupational and Environmental Medicine contained 856 pages in 50 chapters, was published in 1994 in paperback, and received peer review by the publication committee of the American College of Occupational and Environmental Medicine (ACOEM; Dr McCunney was past president of ACOEM). The third edition has 100 more pages, 10 more chapters, and 87 authors with the degrees of MD, PhD, JD, DVM, and PE. The text includes a CD-ROM containing the MOSH Pocket Guide to Chemical Hazards, a public-domain document available from the National Institutes of Occupational and Environmental Medicine.
The organization is similar to other texts of the genre. The reader moves through chapters covering the basic practice of occupational medicine, diseases of organ systems, and toxicology of specific hazards and work environments. Like the competing texts, this one has chapters on environmental medicine, the Human Genome project, and computers and informatics. Two chapters I was surprised to find are "Educational Opportunities" and "Case Report: Discovery of Occupational Disease." Physicians-in-training and in transition should have access to these chapters, which can shape their future. I found all chapters readable, concise, and well edited. With such a large number of authors, the tendency might be for each chapter to stand alone, but this is not the case. For example, the chapter "Risk Assessment in the Workplace" is well integrated with "Environmental Risk Assessment." Effective editing removes contradictions and contributes to cohesion and readability.
The text excels and distinguishes itself from competing texts with its clinical and administrative approach. For instance, many physicians provide examinations for professional truck drivers holding a commercial driver‘s license. The interested clinician finds an entire chapter on the clinical approach to the examination by the author of a specialty book on the subject. Work restrictions are always difficult for the busy clinician to write. The chapter "Medical Center Occupational Health" has a table of work restrictions for health care workers exposed to infectious diseases. The chapter "Workplace Safety" has an excellent discussion about the work relatedness of injuries and illness and the importance of accurate work restriction statements. Upper extremity disorders are the source of frequent complaints from industrial workers, estimated at 30% prevalence in any one year. The chapter "Arm Pain in the Workplace" presents an algorithm for evaluating these complaints. The clinical approach continues in the chapter "Clinical Environmental Medicine," in which the approach to lead poisoning of industrial workers and pediatric patients is outlined.
Health system administrators typically try to provide occupational medicine services as an extension of existing primary care clinics, which lasts a few years or until the administrators leave their posts. To avoid this recurring pattern of service availability, then termination, the administrator should read the text‘s first chapter, "Occupational Medical Services," written by the editor (which appears to have originated from a 1997 ACOEM text on the same subject also by McCunney). Administrators who read the chapter will see the folly of treating occupational medicine as a mere afterthought or extension of primary care and will avoid painful termination of service when the differences between the two disciplines become more apparent.
Readers who skip the six appendices will miss information that patients ask about. Appendix D, "List of Carcinogens Rated by the International Agency for Research on Cancer (IARC)," provides agents, mixtures, and exposures. I found this IARC reference handy to share with the inquisitive patient. Unfortunately, I found the CD-ROM cumbersome, and those interested in these exposures provided by the NIOSH guide probably already have the guide.
My criticism of the text concerns the relation between the depth of a topic‘s coverage and its clinical importance. For example, respirators are personal protective equipment that often represent the first line of defense against inhalation exposures. Respirator users require a medical clearance enforced by an Occupational Safety and Health Administration (OSHA) statute. The text covers respirators incompletely and their medical clearance even less so. In contrast, the chapter "Occupational Medicine Aspects of Terrorism" describes clues to detecting potential mail bombs. In my practice, respirator clearance is far more important than screening my mail for bomb clues.
The third edition of A Practical Approach to Occupational and Environmental Medicine represents a formidable contribution to the specialty and a readable choice for the clinician. Perhaps issuing it in hardback indicates the publisher‘s intent to demonstrate the considerable wealth of information between the covers.
[Footnote]
1. Allen JW, reviewer. JAMA. 1998;281:2347. Review of: Rom WN, ed. Environmental and Occupational Medicine. 3rd ed.
2.Allen JW, reviewer. JAMA. 2000;284:1985. Review of: Baxter PJ, Adams PH, Tar-Ching A, Cockcroft A, Harrington JM, eds. Hunter‘s Diseases of Occupations. 9th ed