A patient’s job can offer important clues about their health, but understanding the relationship between work and illness requires more than asking what someone does for a living. Workplace conditions, physical demands, staffing, and exposures can all influence a patient’s well-being and ability to recover.
Through an Occupational Medicine elective offered by the Department of Internal Medicine, Carver College of Medicine students can explore those connections firsthand. Christopher Iverson, MD, MBA, MPH, clinical associate professor in Pulmonary, Critical Care, and Occupational Medicine, hopes the students he works with leave the rotation with a better understanding of how occupational factors influence patient care, regardless of which specialty a trainee ultimately pursues.
“Work is part of nearly every adult’s daily life, and how much work and health affect each other is often underestimated,” Iverson said. “The rotation gives them a practical toolkit for work-related questions that will inevitably come up at some point in their career.”
For Fallon Jung, a Carver College of Medicine student who completed the elective, this perspective became one of the most valuable lessons of the rotation.
Jung first became interested in occupational health during her Family Medicine rotation, where she helped care for a patient with a shoulder overuse injury. The clinic was located in town with a large meatpacking plant, and she began to recognize how closely patients’ jobs were tied to their health.
One particular experience during the Occupational Medicine rotation gave her a broader understanding of the challenges patients can face when an injury affects their ability to work.
Jung recalled an older factory employee who came in with a painful shoulder and back injury. This patient was one of about five people who held his position at the company. However, with his coworkers either out on vacation or missing time due to their own health reasons, he was the only employee staffing his position at the time of his occupational health evaluation. When the occupational health team recommended modifying his work duty status, the injured worker voiced a desire to continue working despite significant pain, explaining that if he stopped working, the factory couldn’t run and his coworkers in other divisions would be unable to work.
“He felt a moral duty to continue to work at the expense of his health” Jung said. The experience reinforced the importance of considering a patient’s working conditions when developing a treatment plan.
Learning outside the clinic
The Occupational Medicine elective is an advanced clerkship for Carver students, who work alongside a board-certified Occupational Medicine faculty in several settings. They gain experience with work-related injuries and illnesses, fitness-for-duty evaluations, medical surveillance exams, and employee health.
The rotation also takes students outside the clinic through visits to local workplaces and industries. Seeing production lines, job sites, and laboratories firsthand helps students better understand the exposures their patients may encounter.
Iverson said these visits are consistently among students’ favorite parts of the elective. Students also spend time in the University Employee Health Clinic, where they see how occupational health professionals protect UI Health Care employees from infectious disease exposures and help injured or ill colleagues return to work safely.
Beyond recognizing workplace hazards, Iverson hopes students develop the skills to ask more detailed questions about a patient’s employment history and understand how that information can influence care.
“When we take the time to ask what a patient actually does day to day, how long they’ve done it, what they’re exposed to, what protective equipment they use, and what jobs they’ve held in the past, we learn a great deal, both medically and personally,” he said. “That work history can uncover the cause of a puzzling diagnosis, flag a risk to coworkers, or reveal what a patient needs to safely return to the job that supports them and their family.”
Iverson added that students learn how to communicate with employers while protecting patient privacy. They also gain a working knowledge of the workers’ compensation system, which can seem daunting to patients and physicians alike. According to Iverson, this hands-on exposure prepares students to help their future patients obtain the medical care they are entitled to under workers’ compensation benefits.
A broader view of patient care
For Jung, the elective ultimately changed how she thinks about medicine and the communities her future patients live and work in.
She learned that Occupational Medicine has a significant public health component, with decisions sometimes affecting people well beyond the patient sitting in the exam room. For example, evaluating whether a commercial driver is medically fit to drive requires physicians to consider not only the driver’s health but also the safety of everyone sharing the road.
Jung said the experience has even influenced the questions she asks during residency interviews. She now makes a point of learning about the major industries in the surrounding area and how those jobs might affect the patient she could eventually treat.
“I originally joined the rotation just to get a better sense of workers’ comp, something that I assumed was, honestly, just a little boring and complicated,” Jung said. “I will say, it is a little complicated—workers’ comp varies from state to state. But, with the amazing faculty and staff on the Occupational Medicine team, I never had a boring day.”