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OCCUPATIONAL MEDECINE
OF THE FUTURE IN FRANCE
« Tout travail suivi fait paraître une aptitude » - Alain, éléments de philosophie (1916)
Dr Faïza Bossy,AssociationHorizonSantéTravail,Asnières,France  

INTRODUCTION

: f.bossy@horizonsantetravail.fr

CONTEXT (2015 ANNUAL REPORT IN AN INTER-COMPANY
OCCUPATIONAL HEALTH SERVICE)

 28.5 million active workers inFrancein2015

TYPES OF VISITS

 1.5 millionhadhealthproblemsrelatedtowork
 750,000 fit to work with restrictions

  729 visits

 150,000unfittowork: that is as many potential unemployed

 13% reinstatement visit: thepractitionerhastoquicklypronouncethefitnesstowork,and
if the reintegration is possible

 Unemployment reaches 10.3 % of the active population in France

 2.5% pre-reinstatement visit: thisrate is toolow,thepre-reinstatementvisitis essentialto
calmly plan the reintegration and facilitates the upholding of employment.

The decisions of occupational practitioners directly and indirectly impact the whole society and its economy. The old employer-employee-practitioner scheme fails to address the
evolutionofsociety.Anewmodelhastobeadvancedandimplementedonthebasisofourscientificknowledge.
Occupationalmedicineneedstooperateonallpreventionlevels,andnottoberestrictedtotertiaryprevention,orsecondarypreventionatbest.
The occupational practitioner has to initiate a dynamic process focused on the employee.

53

 Whypre-reinstatementvisitsareignored?

 Howtoshiftfrom“unfittowork”to“fittowork”?

 Age:59
 Gender:Female
 Marital status:
Divorced
 Family status:
2 independent children
 Financial status:
independent,tenant

PRE-REINSTATEMENT VISIT

Habitus

1

0

0

emergency

6

others

employee

occupational
practitioner

total

occupational
disease

0

REINSTATEMENT VISIT

Occupational
health department

 BUDGET
 PEOPLE
 ASSETS
 TIME

occupational
accident

sick leave

total

GP

2

recurent leaves

 Isgoodhealthatworkanexclusivepreoccupationofoccupationalmedicineservices?

2

9

6
maternity leave

 Whyreinstatementvisitsareoverwhelmingafteramedicalleave?

5

SS medical advisor

QUESTIONS

13

employee

total

9

18

employer

In order to meet this requirement we will present a clinical case using the methodology of AJLP Conseil & Formation.

MATERIALS AND METHODS: CLINICAL CASE

35

34

OPTIONAL MEDICAL EXAMINATIONS

 Evaluationofprofessionalactivity
 Website
 Flyers/Ownpublication
 Meetingthetargetpublic
 Teammeeting
 «Gostraight»tothesource:visittheworkplaces

Employee

 Lookafterherhealth:Backpainpreventionclasses...
 Examinehersprioritiesandherneeds
 Tobeactoronaproject:personalplan,retirement

Employer

 Assessment
 Management
 Socialdialogue/PrivilegedpartnershipwithOHD*

REQUIREMENTS
 Jobpost
 Interview,exams,andassessment

 Fit to work

Recurrent exam

 Interview,exams,andassessment
 Professionalproject

 Fit to work

MILESTONE M24.

 Therapeuticstrategies:Newmodel

Pre-recruitment exam
 Diploma: Catering and hotel
 Waiter, Maître d’hôtel
 Cooker, Chef
 Restaurant manager
 Restaurant owner for 10 years
 Maître d’hôtel in a Retirement home:
-Permanentpositionsince25thJune2012
- Full-time
- Workinghours:10h-20h,2WE/month,alternates2W-5Dand2W-3D
- Commuting: 1 hour by public transport

Curriculum laboris

THE CASE

PROJECTS

First pre-reinstating visit
MILESTONE M33.
 Therapeutic management,
Activating networks, and Medical monitoring

JOB DESCRIPTION
 Teamleader
 Presentfood,Laytables,Serveattables
 Welcomeandinstallthecustomer,Guideandtakeorders,respectdiets
 Handleatrolley,Manualhandling
 Cleardishes,Cleantables,Cleantherestaurant
 Resolveconflictswithpatients,families,andcolleagues

month medical leave: Spine surgery, Functional
Second pre-reinstating visit  5physiotherapy,
Medical treatment.

Maître d’hôtel

TOOLS

HEALTH CONSEQUENCES
 Medicalleaves
 Occupationaldisease:#57intheofficialSStable
 Otherdiseases:rachidian,lowerandupperlimbspain

MONITORING

MILESTONE M40.

 Interwiew , examen and assessment
 Professional future: occupational reclassification or
professional reintegration?

 Advices to employee and employer

OCCUPATIONAL HAZARDS
 Bio-mechanicalrisks
 Chemicalrisks
 Biologicalrisks
 Sensoryrisks
 Mentalworkload
 Organizationalrisks
 Contactwithfood,Hygienestandards,Serviceuniform

 4 month medical leave: Radicular/sciatic pain, Muscle strain,
Left hip pain, Medical and physical therapy, Back brace
 Medical assessment and functional abilities evaluation
 PRIORITIES
- Employee: back to work without pain, previous life
- Employer: organizational legacy, short-term economy
- Society: reduce economic, social , human costs

Reinstatement visit
MILESTONE M41.
 Accessibility: contact/ referent...
 Safeguarding employment Dynamic: contract between
employee and occupational health department( OHD)*
 TASKS DELAYED
 TASKS ON HOLD
 TASKS IN PROGRESS
 Participatory dialogue with the employer

 Medical and psychological exam
 Coordinated action: employer, employee, and medical network.
 Increase and improve the working conditions
 Make proposals
 Overall approach

Post-reinstatement visit
MILESTONE M46.

 In-situ observation
 Objectives
- Increase and improve
the working conditions
- Make proposals
- Overall approach

CONCLUSION
Partnership between the employee and the occupational medicine services using the «Dynamique du maintien en emploi» tool. The employee gave their
informed consent for the support in their professional career.
Rally of a multidisciplinary team of occupational medicine and other services:
 Occupational practitioner and their team (ergonomist, social assistant, psychologist)
 GP, hospital, physiotherapist (« Ecole du Dos »)
 SS medical advisor
 Administrative services: SAMETH (skills appraisal, vocational training)
 Financial services: AGEPHIP (subsidies)
The follow-up is critical and must be done as a team. Delegation allows to save time.
 For the employee: regainconfidence,supporteachstepintheircareer,awarenessofprofessionalrisks(primaryprevention),beactiveabouttheirhealthat
work,relayinformationstocolleagues.
 For the employer: supportthequalityimprovementprocess,trainemployees,awarenessofprofessionalrisks,costspreventionarelowerthanmedicalleave
/employmentbreak,benefitsintermsofimagewithregardtopartnerbusinessesandclients.
 For occupational medicine services:
- Primary mission: primaryprevention:anticipationofrisks,passinformationsaboutprofessionalrisks,communicatewithemployees,employers,medical
andnursingstaff,colleagues,inordertodelegateandsaveone’sowntime.
- Secondary prevention:activatenetworks,raiseawarenessabouttraining,involvetheemployeetotheprocess,meettheemployersinthefield,establish
a plan shared by all.
- Tertiary prevention: findappropriatesolutionsfortheworkstation,converttheworkstationwiththecooperationoftheemployer,maintainthecontract
andtheemploymentdynamics,maintainthenetworksactive.Donotgiveup,trynottodeclareunfittowork.
If an employee must be declared unfit to work, they must have consented and experienced as a second chance because other solutions have been
considered upfront.

Acknowledgements:ThisworkwasfundedbyAssociationhorizonSantéTravail,theauthorisemployedbythiscompany.MrMatte(ergonomist),MrsRichardot,DanièleGounot(Administrativesupport),PrGehano(Guidance)
DrRobertBossy(Translation,support),SauniaChouarfi(Technicalsupport)(layout)

 Therapeutic part-time working



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