A physical exam in occupational medicine includes medical history, vital signs, and assessment of body systems, augmented by work-related components associated with regulatory compliance, injury prevention, medical surveillance, and disability avoidance.

Getting the Right Work Physical

A general physician might answer the question, “What does a physical consist of?” with a list of body systems to be assessed and lab work to be done. An occupational health clinician is likely to address those aspects in a physical exam, too – while also going a step further by asking about the employee’s work environment and job requirements. A national occupational health organization with Concentra’s 40-year history and extensive clinical expertise will provide the right work physical for the work the employee needs to do.

Overview

In occupational medicine, clinicians address the needs of employers and their more than 130 million employees¹ across a hundred recognized industries² to help prevent and manage injury, illness, and disability in the workplace. They also help keep employers and workers in compliance with millions of federal and state regulations and laws. For them, the physical examination is a valuable element of the occupational medicine toolkit. Given the complexities of the specialty, you begin to see why a question, “What does a physical consist of?” needs a detailed response.

As a brief overview, we can look at work-related physical examinations in four categories, based on when they are done or the purpose they serve:

1. Physical exams performed before work begins
2. Regulated physical exams
3. Medical surveillance/hazardous substance exams (also regulated)
4. Return-to-work and fit-for-duty physical exams

Physicals before work begins include two major types. Pre-placement exams and functional capacity evaluations match physical capacity with requirements of the job.

Regulated physical exams can help keep employees compliant with industry/government requirements. This encompasses interstate commercial drivers of trucks and buses, commercial pilots, maritime workers, military, police officers, firefighters, and more.

Exams for medical surveillance (baseline/ongoing screening), exposure to bloodborne pathogen or hazardous substances, and respirator medical clearance/respirator fit tests are mandated by the federal Occupational Safety and Health Administration (OSHA) for worker health and safety to help prevent injury and monitor exposures.

Fitness-for-duty and return-to-work physical exams support the employer’s efforts to keep workforce health and safety awareness and fitness high over time. These exams can aid in averting repeated injury or illness, thus, helping to reduce workers’ compensation costs.

Now let’s answer the question – What does a physical consist of? – from a general perspective and then from the point of view of different employees.

What Does a Standard Physical Consist Of?

Prior to any physical examination, the employee completes a questionnaire to provide a comprehensive personal, occupational, and medication history. At Concentra, clinicians review the questionnaire and the employee’s test results as they conduct the physical exam and address any findings that may pose immediate risk to health or life.

If an employer has specific physical exam requirements, Concentra incorporates those elements in the exam. In general, the standard physical exam typically includes:

• Vital signs: blood pressure, breathing rate, pulse rate, temperature, height, and weight
• Vision acuity: testing the sharpness or clarity of vision from a distance
• Head, eyes, ears, nose and throat exam: inspection, palpation, and testing, as appropriate
• Gastrointestinal examination: may include any of inspection, auscultation (listening for bowel sounds), percussion (a special tapping technique to deduce any tenderness), or palpation (a touching technique using the clinician’s hand on the relevant body part, in this case, abdomen, to observe any muscle guarding, rigidity, or tenderness)
• Cardiovascular evaluation: general appearance, inspection of eyes (retinal arteries) and heartbeat, blood laboratory tests, and when required by regulations, electrocardiogram
• Respiratory assessment: respiratory rate, observation of skin appearance, breathing sounds and postures. Employees at workplaces required to have a respiratory protection program may also undergo respirator medical evaluation for respirator use.
• Musculoskeletal assessment: Muscles, bones, and joints are assessed by functional grouping using techniques of inspection, palpation, and manipulation (applying pressure or movement) while the clinician observes responses and reactions.
• Neuro exam: observation and testing or observation alone of mental awareness, motor function and balance, sensory response, and nerves/reflexes
• Skin and lymph node check:  skin tone/pallor and lymph nodes are inspected