P. R. ELLIS AND G. I. WALTERS: OCCUPATIONAL ASTHMA IN ACUTE SECONDARY CARE 59 5. de Bono J, Hudsmith L. Occupational asthma: a commu- 8. Research Randomizer. Random Sampling and Random nity based study. Occup Med (Lond) 1999;49:217–219. Assessment Made Easy! https://www.randomizer.org/ (26 6. British Thoracic Society. British Thoracic Society/SIGN March 2017, date last accessed). Asthma Guideline 2016. https://www.brit-thoracic.org.uk/ 9. Walters GI, Kirkham A, McGrath EE, Moore VC, document-librar y/clinical-information/asthma/btssign- Robertson AS, Burge PS. Twenty years of SHIELD: asthma-guideline-2016 (25 March 2017, date last accessed). decreasing incidence of occupational asthma in the West 7. World Health Organization. ICD-10 Version: 2016: X Midlands, UK? Occup Environ Med 2015;72:304–310. Diseases of the Respiratory System. http://apps.who.int/classi- 10. Fishwick D, Bradshaw L, Davies J et al. Are we failing fications/icd10/browse/2016/en#/X (25 March 2017, date workers with symptoms suggestive of occupational asthma? last accessed). Prim Care Respir J 2007;16:304–310. doi:10.1093/occmed/kqx190 Fifty years ago: The scope of occupational medicine in a university health service Anthony Ryle Director, University of Sussex Health Ser vice psychological or academic breakdown. Secondly, what in the institution may have promoted, and what could While university occupational health includes clas- have prevented or may limit his breakdown. sical, formal environmental health problems such as Meanwhile, how much can be done by a University laboratory safety, radiation and so on, its central con- Health Service to modify the institution in such a way cern, I believe, should be with the main function of as to diminish problems among students? At Sussex, the University as an institution, namely, teaching and various processes are under way which I think can have learning. The aim of a University Health Service in such an effect. In the first place all students in severe this context is to minimize failure and under-achieve- academic difficulty are reviewed by a central commit- ment among students. To achieve this aim involves an tee of all the Deans on which I sit, and at which medi- extension of the doctor’s role beyond the detection and cal information on those students who give permission treatment of illness, and beyond a concern with formal can be presented. In this way, recognition of the role psychiatric illness, to a concern with what I call the ‘irra- of psychological factors in promoting work difficulty tional transaction’ between the student and his teacher has been established throughout the University. In the at the University. To develop a Health Service, which can case of students with such difficulty who are under work along these lines, one must follow certain stages. treatment, direct discussions with the tutors involved Firstly, one must create a satisfactory clinical service, can go some way further towards enabling the tutor to because upon this depend the basic attitudes of the stu- understand what is happening between him and the dents and the University to the doctors. Secondly, the student, a process which must at times involve him doctors will intervene, on behalf of student patients, in examining his own reactions. Finally, by seminars with their tutors where illness or disability has inter- and 1-day conferences for tutors, we have undertaken fered with their functioning. Thirdly, partly through some more or less formal education and exchange with such intervention, the doctor can begin to extend the tutors about the irrational components of the teach- general understanding of his role to include a recogni- ing situation. I believe that it is in these ways, and in tion of the part he can play in understanding the tutor– cooperating with others in research into the teaching student interaction. If he is accepted in this role, then process, that a University Health Service can carry out a fourth stage becomes possible in which the Health its specific form of occupational medicine. Service is formally involved in policy making, in teach- ing of tutors and so on. When the doctor in his occupa- From: The scope of occupational medicine in a uni- tional role is faced with a student who is a psychiatric or versity health service.Trans Soc Occup Med (1968) 18, an academic casualty, I think he should ask himself two 28–29. Available at: Occup Med (Lond) 1968;18:28–29. kinds of question. Firstly, he must ask what, in the his- https://doi.org/10.1093/occmed/18.1.28 tory and the personality of this student, predisposed to Downloaded from https://academic.oup.com/occmed/article-abstract/68/1/59/4866354 by Ed 'DeepDyve' Gillespie user on 16 March 2018
Occupational Medicine – Oxford University Press
Published: Jan 1, 2018
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