Generally, when new hires receive pre-placement medical examinations,
physician examiners have few resources to utilize when considering an
individual for placement. All too often the employer does not
provide the examiner with a job description or one in sufficient
detail. It is not uncommon for the examiner to only know the name
of the organization for which the potential employee is being examined
and nothing about the occupation in question.
The MED-TOX Medical
Guidelines have been developed to be a reference work to be
consulted when an individual presents with a potential disability or
medical limitation during the pre-placement medical examination.
The guidelines are most useful when considering persons for placement
when the job has been analyzed using the MED-TOX physical abilities and
working conditions analysis approach.
For each medical condition, the guidelines list the job-related factors
(physical abilities and working conditions) that should be evaluated by
the examining physician prior to making a placement
recommendation. The guidelines make clear that they are directed
toward assisting the medical examiner make a more job-related screening
recommendation than might otherwise be made because the guidelines
delineate the linkages between the medical condition and the job itself.
Since there can be a wide variation in the functional capacity for
individuals with a given diagnosis, the guidelines give the physician
considerable latitude in making a placement recommendation. The
guidelines do, however, point out the physical and environmental
factors that require an individualized post offer assessment.
One reason for our intensive focus on linking jobs to medical
conditions is that many studies have documented the wide variability in
the decisions of physician examiners regarding job placement and
disability status. We have focused on providing job analysis
information as a means to reduce the potential for inconsistency among
physicians due to a lack of specific information concerning the
physical abilities and working conditions imposed by the work.
With clear and organized job information, physician agreement about job
placement should be enhanced.
Our approach in organizing the Medical Guidelines is by
medical condition. With each medical condition is a description
describing the implications for job placement for each. The
medical examiner then reviews the job analysis results and compare
those results to the medical condition and the recommendations in the
manual. The medical guidelines are useful whether the job
analysis results are for a Deputy Sheriff, Warehouse Worker, or any
other job (providing the appropriate job analysis has been
conducted). A particular condition may have major implications
for one occupation and few or none for others.
One of the greatest strengths of the Medical Guidelines are that
they are universal. The attempt to devise a specific set of
medical guidelines for each occupation would be an endless and
expensive endeavor. Two jobs may have completely different job
tasks but be very similar in the level of ability
needed for successful job performance. Since the Guidelines link abilities
to medical conditions, the need to initially consider individual tasks
is unnecessary. Tasks should be considered when the Guidelines demonstrate a
mismatch between the medical condition and the physical demands of the
specific occupation under consideration.
The Medical Guidelines
are designed to assist examiners in closely focusing on the actual
physical demands and working conditions of the job and link those
demands to the medical conditions. This linkage allows for an
individualized assessment of the individual in relation to the job as
required by law. The individualized assessment must be made by
the medical examiner after examining the individual, medical history,
any current condition and prognosis, and functional ability in relation
to the actual job requirements.
In 1992 the Equal Employment
Opportunity Commission's (EEOC) final regulations implementing the
Americans with Disabilities Act of 1990 went into effect. These
regulations (29 CFR 1630.14 [b] ) clearly state:
conducted in accordance with this Section do not
have to be job-related and consistent with business necessity.
However, if certain criteria are used to screen out an employee or
employees with disabilities as a result of
such an examination or inquiry, the exclusionary criteria must be
job-related and consistent with business necessity, and performance of
job functions cannot be accomplished with reasonable accommodation as
required in this part.
No federal regulation requires that the content of the post-offer
pre-placement medical examination be job-related. In fact, the
medical examination should be as comprehensive as is economically
feasible. What must be job-related are the medical decision
making criteria (job analysis and medical guidelines) to be used by the
employer in making medical employment selection decisions.
Guidelines define the relationship between disease states and
the physical demands and environmental hazards of jobs. They
serve as one tool to assist the employer and examiner conduct
job-related medical screening.
Guidelines offer a practical and efficient means of linking
occupational medical considerations to job analysis information.
Any employer can utilize the guidelines to the extent the physical
demands and working conditions of
the job have been specified. The MED-TOX Medical
compatible with the O*NET job analysis system. O*NET is the U.S.
Department of Labor's new occupational information system that will
replace the outmoded Dictionary
Titles in the year 2000. The O*NET system is completely
compatible with the Medical
Guidelines since both
utilize the same physical ability dimensions and measurement
tools. As employers move towards O*NET methodologies, the Medical
Guidelines will be readily available for a variety of uses.
Physicians have job analysis
information and occupational medical information to consider as
they consider appropriate decision. Placement decisions are more easily
defended since they are
based on the job.
- Provides detailed information
regarding the actual physical
abilities and working
conditions encountered in physically demanding
- Establishes a linkage between
screening decision making and the
demands imposed by the job.
- Provides examiners with
occupational medical information
regarding the placement of persons with medical conditions into jobs
with significant occupational exposures.
- Allows for medical examinations to
based on the job which can eliminate
unnecessary medical testing.
- Bolsters the employer's ability to
defend medical screening decisions
since evidence exists that screening decisions are job-related and
linked to the essential functions comprising the job.
- Lessons the demand the every
examiner be an expert in each of
the diverse areas of the medical sciences.
- Provides for an individualized
assessment yet yields consistent results
among physician examiners.
- Pinpoints areas that may need
- Complies with the Americans with
Disabilities Act of
Contact MED-TOX about the Medical Guidelines and how
your organization can utilize physical abilities and working conditions
analysis for medical screening or to devise job related
tests of physical ability.