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Pre-employment medicals work

More employers are realising the advantages of pre-employment medical examinations.

Traditionally the domain of large employers, such as government departments, utility companies, law enforcement, mining and transport companies, pre-employment medicals can also provide benefits for small to medium enterprises, especially those in the hospitality and retail sectors.

Pre-employment medicals equip employers to manage any potential risks to the health and safety of their workforce and can also assist job applicants - detecting any previously unknown health issues.

It’s a complicated area of recruitment, where employers must comply with anti-discrimination and privacy legislation while considering which tests to include.

Pre-employment versus pre-placement medicals

There are two types of medical examinations in recruitment - pre-employment medicals and pre-placement medicals.

Pre-employment medicals are designed to assess a prospective employee’s suitability for the position. They evaluate whether the role may need to be modified to suit the applicant and they also provide baseline health tests, such as hearing and lung function, to enable the employee’s health to be tracked throughout their career.

Pre-placement medicals are examinations conducted after the employment of a person to identify any workforce modifications needed to suit the employee, in a bid to improve their productivity and reduce their risk of injury and illness.

Dr James Ross, Medical Director at Aspen Corporate Health, says pre-employment and pre-placement medicals are designed to assist people, not prevent them, from working.

“Occasionally there will be applicants who are not suited due to the physical demands or quite specific requirements of the job,” he says.

“For the vast majority of applicants, it may be a case of needing to modify the workplace for them to perform their job better.”

Tailored safety tests

Dr Ross says it’s imperative pre-employment medicals are tailored to address the intrinsic requirements of individual positions, instead of a one-size-fits-all approach.

“Pre-employment medicals are extremely important and beneficial to both employer and employee if they are done properly,” he says.

“If they are generic they don’t help very much at all. The employer needs to sit down with the provider to come up with an appropriate and targeted approach to pre-employment medicals.”

Pre-employment medicals should include a questionnaire, to be completed by the applicant, and a medical examination, both targeted to the position.

For safety sensitive roles, such as drivers or heavy equipment operators, Dr Ross says pre-employment medicals should examine an applicant’s cardiovascular risk and whether they suffer from sleep apnoea - a common and often undiagnosed condition.

In positions that involve confined spaces and working at heights, he says examinations should focus on specific components, such as the psychological and physical capabilities, needed for the role.

“For employees working at heights, an examination should determine any mental health concerns about being at heights and whether they can safely climb ladders - so whether they have any knee or hip problems,” he says.

“Often people working in confined spaces need to wear a breathing apparatus, so they need to be assessed for their respiratory health as well.”

Baseline health tests for hearing and lung function also have a vital role to play in pre-employment medicals.

“Employees who may be exposed to some noise, asbestos workers or gardeners working with organophosphate pesticides - these employees should have tests before they start and then regularly throughout their employment,” Dr Ross says.

Psychological screening, drug and alcohol testing

Employers are increasingly requesting drug and alcohol testing as part of their pre-employment medicals.

Dr Ross says employers can overestimate the importance of the tests.

“Drug and alcohol testing is designed to either identify people who are going to be impaired in the workplace and are not going to be able to do their job properly or are going to be a safety risk for themselves or others.

“But drug and alcohol testing isn’t a test of whether they are impaired or not - it is a test of whether they have consumed alcohol or used a drug. It’s only a partial answer to the issue of drug dependence.”

Employers should negotiate with their workforce and unions before embarking on a drug and alcohol testing regime, he advises.

“Employers need to have a detailed policy in place about what is and isn’t acceptable and about any repercussions.”

Dr Ross says psychological screening is important in particular areas such as military and law enforcement but there’s little evidence of the value of psychological screening for other employment fields.

Privacy and consent

While employers pay for pre-employment medicals, they are not entitled to view the examination results.

Instead, employers receive a doctor’s recommendation outlining whether the applicant is fit or unfit for the role, or fit with modifications.

“There is no requirement for the employer to know diagnoses, they will only need to know what the consequences on the workplace will be as a result - for instance, that the individual is not suitable to drive as part of their work,” Dr Ross says.

“The employer would only be able to see the complete examination results if the applicant provides consent for the results to be handed over to the employer.”

The right provider

To get the best outcome, Dr Ross says employers should choose a provider specialising in occupational health.

Many general practitioners are not best placed to provide pre-employment medicals, he adds.

“If you send the applicant back to their own GP, the reality is that the GP is the patient’s advocate. There can be suppression of certain aspects which can have a negative outcome for everyone.

“You need someone who is very familiar with workplaces, knows what the demands are of a particular workplace and can match that to the individual and the components of the pre-employment medical.”

Dr James Ross is Medical Director at Aspen Corporate Health.