PHYSICAL EXAM: FREQUENTLY ASKED QUESTIONS
Why do employers require a physical exam and what standard do we use?
If you have been referred to us for a work-fitness exam, it usually is related to remote work location or travel-intensive assignments. The employer requires that any problem that may pose a significant impairment in you doing your job or which may put you or co-workers at risk be evaluated by us. Further, we are to either use standards required by the particular occupational exam (such as Oil & Gas UK, formerly UKOOA) or our reasonable medical judgment to decide whether you pass, fail, or pass on probation, pending satisfactory disposition or resolution of the problem.
Probation requires that,
further expert evaluation of the problem provides medical clearance or,
IMC feels the problem does not pose a risk or contraindication to the job or an immediate risk to you or others, but must be further defined and/or managed to the satisfaction of our physician.
How long do exams take and when are they scheduled?
Most IMC physical exam clients want to know what to expect of the process since they must plan their day around the exam.
In general, we try to schedule exams in the morning because labwork is often most valid if done fasting (8-10 hours), and we try to schedule the same day any other services deemed necessary after our doctor’s evaluation that could not be otherwise anticipated (cardiac stress tests, for example). The aim is to avoid having the patient return another day, as most often they are already pressed for time to depart for the work assignment.
All exam types have their own specific requirements, so estimates on the duration of time are approximations. On average, you should plan between 2 and 3 hours at least, and if no unanticipated further evaluations are needed.
What are some common problems patients encounter that could prevent work approval?
We must make clear that it is not uncommon to find problems that require evaluation and action for you to be deemed fit for extraordinary work opportunities. The worst situation we encounter is an individual urgently needing to fill a job and an employer hoping for an expeditious medical clearance, only to stop the process because of a legitimate medical problem or the risk of one. This most often happens with individuals who,
have not kept up with routine, age-appropriate wellness medical and dental exams and recommendations.
are morbidly overweight (BMI>35).
smoke or excessively drink alcohol.
have poor dental condition.
have poor vision, with no prior correction or with maximum corrective effort.
have poorly controlled underlying medical problems (diabetes, high blood pressure).
have poor hearing (not previously evaluated or corrected).
are 50 years or older and have never had a cardiac (heart) stress test.
How can I avoid delay in work-fitness approval?
In order to avoid delays in work-fitness approval, we advise the following,
Bring any reasonable recent (within the past year) medical lab or other diagnostic test reports to the exam. We cannot guarantee that such prior tests will be acceptable at the time of the exam. Such information may be out of date for a particular problem.
If you are older than 50 yrs old consider getting a cardiac stress test (by a cardiologist) and bring the test results to your exam.
Factors that may require cardiac stress testing under 50yrs-old.Significant history of personal or family heart disease
Smoker
Hypertension
Diabetes
High cholesterol (or other blood lipids)
Overweight
Sedentary
Consider visual (ophthalmologist) check-up and hearing test (audiogram by ENT specialist or audiologist), if you think you may have such problems. Bring the test reports and the written recommendations of the specialist.
Consider a dental exam and any necessary treatment if more than a year since last dental exam.
Bring documentation of your most recent medical or dental evaluation with comments on specific medical problems that may stand in the way of a work-fitness clearance (hypertension, diabetes), with the opinion of the managing physician regarding your work fitness (for remote work) related to the problem.
Make sure the physician records his/her name, specialty, board-certification status, and opinion on medical work-fitness, and contact information (in case we need to discuss their opinions and recommendations). Most often, only the opinions of a physician (M.D. or D.O.) will be acceptable (no physician “extenders”).
ATTENTION: Be sure to take your regularly scheduled medications without interruption so that problems that are usually controlled (blood pressure, blood sugar) do not register as out of control during the exam (eating a small piece of dried toast for meds that require food will not violate the fasting requirements).
ATTENTION: Understandably, an employer may decide to hold on approving proceeding with vaccinations needed for the work assignment and may even delay work exam completion (to minimize cost) until IMC can provide medical work-clearance for PERSONAL MEDICAL PROBLEMS by further evaluations.
If you are ON A TIGHT TRAVEL OR JOB ASSIGNMENT TIMELINE, BE PREPARED TO PAY FOR ADDITIONAL TESTS/EVALUATIONS (cash, verifiable credit cards, health insurance) at the time of your appointment.
If any of this pertains to you, CONTACT IMC IMMEDIATELY. Depending on the medical problem(s) relevant to you,
Forward your height/weight.
Forward recent blood pressures.
Send/FAX/email recent medical records.
Fill out medical history forms at home and forward them to us ASAP.
Schedule any extra tests (that we will require) where you live with an appropriate specialist (pre-approved by IMC) with results forwarded to us ASAP.
We have provided this information to minimize the chance that you will encounter unexpected, additional testing or expense or that you will be delayed in proceeding to your desired job assignment. We hope that by proactively giving you this information, we can expedite the process and achieve a medical work-fitness rating without delay. IMC will work with you to serve your and your employer’s interests, while never compromising on medical issues that could put you or others at risk.
ALERT: Be sure to bring eye glasses, eye contacts; hearing aides; or any other equipment/devices you use to neutralize or diminish a defect or impairment.
Edward R. Rensimer, MD
Director, IMC