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The preplacement evaluation.

Abstract

Over the past 25 years, the preplacement evaluation has undergone considerable evolution under the influence of regulatory and economic pressures. Formally used by some employers to screen out applicants who might have represented the mere possibility of a future work-related injury, the modern-day preplacement evaluation is legally restricted to only two determinations: (1) whether the individual can perform essential job functions with or without accommodation and (2) whether the individual represents a direct threat to himself or herself or others. Truly enlightened companies also recognize that other benefits accrue from a properly designed, conscientiously performed preplacement evaluation, perhaps the most important of which is to promote worker health, in the certain recognition that healthy employees are more productive ones. This benefit may be the true purpose of the preplacement evaluation and its most enduring, tangible benefit.

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BibTeXRIS

E P Horvath. 1999. The preplacement evaluation.. https://doi.org/10.1016/s0025-7125(05)70181-4

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Medical Geneticists' duty to warn at-risk relatives for genetic disease.

A patient who refuses to notify their relatives of potential at-risk status brings a genetics provider to face conflicting ethical principles and ill-defined legal precedent. Genetics professionals' views on the disclosure of patient information to at-risk relatives have remained largely unexamined. Prior analyses have been limited to identifying factors contributing to genetics providers' self-predicted responses in hypothetical scenarios. Our group was the first to examine the clinical experience of genetic counselors with this issue [Dugan et al., 2003]. We report here results from our follow-up survey of medical geneticists who are members of either the American Society of Human Genetics and/or American College of Medical Genetics in an effort to identify their experiences in warning at-risk relatives and the factors driving their decision-making processes. Over two-thirds of medical geneticists surveyed (69%, 143/206) believe they do bear responsibility to warn their patients' relatives when found to be at-risk for genetic disease. One-quarter (25%, 31/123) of medical geneticists who faced the dilemma of a patient refusing to notify their at-risk relatives seriously considered disclosure to those at-risk relatives without patient consent. Only four respondents proceeded to warn at-risk relatives of their status. Whereas genetic counselors cited emotional issues as playing a primary role in their decision not to warn, medical geneticists identified patient confidentiality, eventual case resolution by other means, and legal liability as the major factors leading to non-disclosure in 76% of actual scenarios. Responsibilities of medical geneticists, genetic counselors, and non-genetics healthcare professionals facing this issue will need to be more clearly defined to provide optimal medical care within the bounds of acceptable practice.

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