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[Qualitative research of contexts of occupational physician's advice].

OBJECTIVES
No consistent procedure has been established for advice given by occupational physicians concerning scope of disease, criteria of diagnosis and laboratory data, and basis of judgment. The aim of this study was to identify practice-based contexts of occupational physician's advice.


METHODS
We interviewed 6 occupational physicians, and held focus group discussions (FGD) involving 19 occupational physicians, academic researchers, and clinical doctors. Scripts of the interview and FGD were coded to identify the contexts of occupational physician's advice. Additionally, to assure the generalizability of the proposed contexts of occupational physician's advice, we also conducted a survey to collect cases of advice, for which the fitness of the proposed contexts was confirmed.


RESULTS
Four contexts of occupational physician's advice were identified from interviews and FGD, and an additional context was detected through the occupational physician's survey, namely Type 1, work potentially affects a worker's health; Type 2, risk management and prevention of accidents relating to disease; Type 3, recommendation to visit a doctor (referral); Type 4, communication to the head of the department/supervisor; and Type 5, fit for work with appropriate adjustment of work environment and/or conditions. All 48 cases collected could be classified into one or more of these five contexts.


DISCUSSION
This study clarified that several contexts exist for occupational physician's advice in practice. The five proposed contexts reveal different responsibilities and judgments between occupational physician, worker, and employer. Understanding the contexts of occupational physician's advice is important for enhancing consensus-building between stakeholders.