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Occupational history and causation
Every diagnosis in a working adult should prompt the questions "what do you do, what are you exposed to, and when does it improve?" – the link between exposure and disease rests on exposure intensity, temporal sequence, biological plausibility and the absence of a better explanation.
Why it matters in the exam
In Stage A occupational medicine this is the opening move of almost every clinical case: a worker with asthma, dermatitis, anaemia or neuropathy, and the question asks for the next step, which is usually to clarify exposures, timing and improvement on holidays. Other questions test the difference between medical causation and legal recognition as an occupational disease, and the tools that help: the occupational disease list, environmental monitoring and the plant's safety files. A student who can build a structured occupational history also handles the harder items, where the distractor is an "ordinary" diagnosis that ignores the job.
Key points
- An occupational history asks about tasks and exposures, not only the job title.
- Improvement on holidays and worsening on return to work are a strong clinical clue.
- Causation rests on exposure intensity, temporal sequence, biological plausibility and no better explanation.
- The safety data sheet and the plant's environmental monitoring are essential sources.
- Recognition as an occupational disease is a legal-administrative decision separate from the medical diagnosis.
Summary table
| History element | What to ask | Why it helps | Exam example |
|---|---|---|---|
| Job and tasks | What is actually done during the working day, not only the title | A title such as "technician" hides the exposure, the task reveals it | Cutting quartz stone for kitchen worktops |
| Exposures | Chemicals, dust, noise, vibration, radiation, shift pattern | Identifies a specific agent | Solvents in painting, isocyanates in spraying |
| Timing | When symptoms started relative to starting or changing the job | Temporal sequence is a condition for causation | Worsening after moving to a new department |
| Improvement away from work | Relief at weekends and on holidays | A strong clue to work-related disease | Asthma that improves on leave and worsens on return |
| Co-workers | Are other workers ill | A cluster strengthens an environmental link | Several workers with the same rash |
| Protection and controls | Protective equipment, ventilation, training, monitoring results | Estimates the real exposure | Ill-fitting mask, no local exhaust ventilation |
In the full version for subscribers
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Sources
- LaDou & Harrison, CURRENT Diagnosis & Treatment: Occupational & Environmental Medicine, 6th ed., 2021 — The occupational and environmental medical history
- ILO, List of Occupational Diseases (revised), 2010 — Criteria for identifying occupational diseases
- Israel National Insurance Regulations (list of occupational diseases), current consolidated version — Occupational diseases schedule
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.