Investigating and advising on work-related health risks
Preventive occupational healthcare is one of the most important tasks dealt with by company-based occupational physicians.
Since 2008 the legal basis for preventive occupational healthcare, its objective, and the methods it applies has been the Ordinance on Preventive Occupational Health Care (Verordnung zur arbeitsmedizinischen Vorsorge, ArbMedVV), which was most recently amended in 2019. Comprehensive, up-to-date information about the provision made available under the Ordinance on Preventive Occupational Health Care is supplied in German on the website of the Federal Ministry of Labour and Social Affairs (Bundesministerium für Arbeit und Soziales, BMAS).
Many questions connected with preventive occupational healthcare are answered by the Federal Ministry of Labour and Social Affairs in its list of FAQs. This page therefore merely gives an overview of the main aspects of the topic.
What is preventive occupational healthcare?
Essentially, preventive occupational healthcare comprises the investigation of work-related health hazards and the provision of advice about such hazards for employees by an occupational physician.
Usually, it is only possible to provide advice if physical examinations have been carried out using a range of medical diagnostic procedures. Where necessary, the occupational physician will explain the examinations they intend to conduct. However, they will only go ahead with these examinations if the employee does not refuse to undergo them. What is important is that the matters dealt with by preventive occupational healthcare and its outcome are private and subject to medical confidentiality.
What is the aim of preventive occupational healthcare?
Preventive occupational healthcare has the aim of ensuring employees are advised about work-related health risks of concrete relevance to their individual circ*mstances, their personal constitution and disposition for instance.
It involves assessing whether problems that impair their health, work-related complaints or conditions for example, have occurred or are possibly to be anticipated on account of their current and previous working conditions. Work-related conditions are to be diagnosed and prevented at an early stage. One example is the diagnosis of hearing impairment among individuals who work in very loud environments.
At the same time, preventive occupational healthcare is intended to help workers maintain their employability. This is illustrated by the prescription of individually tailored ear protection for employees with pre-existing conditions that affect their hearing.
The investigation of individual matters and the provision of individual advice are the most prominent elements of preventive occupational healthcare. The occupational physician is, for example, able to directly advise that ear defenders always be worn and explain how they should be used correctly. Any problems with the ear defenders can then be discussed.
Preventive occupational healthcare is also intended to contribute to the further development of workplace safety and health. For instance, the occupational physician is able to advise the organisation about the procurement of ear defenders. Where relevant, greater emphasis may be placed on the necessity of ear defenders in the instruction given to employees.
What are the essential preconditions for the provision of preventive occupational healthcare?
Preventive occupational healthcare is predicated on the occupational physician being familiar with the employee’s workplace and the hazards that are encountered there. Occupational physicians are able to acquire this familiarity with the workplace by taking part in risk assessment processes.
Employees are given general collective occupational medical advice as part of the instruction they receive about work-related hazards in the workplace and the options for, aims of, and matters dealt with by preventive occupational healthcare.
At the same time, attention also has to be drawn to the fact that workers’ physical fitness and suitability are not assessed during the preventive occupational healthcare process.
Who can access preventive occupational healthcare?
Where preventive occupational healthcare is provided, every employee is able to book a consultation with the occupational physician if a correlation is suspected between health complaints and the employee’s working conditions (elective protective healthcare under sections11 and 5a ArbSchG).
Companies have to regularly offer employees (optional) preventive occupational healthcare and make it possible for them to arrange consultations if particular work-related exposures occur in the workplace. The occasions for the provision of optional preventive occupational healthcare are defined in the annex to the Ordinance on Preventive Occupational Health Care.
Engagement with (mandatory) preventive occupational healthcare is obligatory if particular occupational exposures are experienced in the workplace. The occasions for the provision of mandatory healthcare are defined in the annex to the Ordinance on Preventive Occupational Health Care.
Is it mandatory for employees to engage with preventive occupational healthcare?
Not generally. It depends on the kind of preventive healthcare provided:
- The initiative to engage with elective preventive healthcare has to come from the employees themselves.
- Engagement with optional preventive healthcare is voluntary.
- Employees are obliged to engage with preventive healthcare where it is mandatory. No one can be employed in these workplaces unless they hold an attestation that they have received preventive occupational healthcare.
What medical examinations are conducted when preventive occupational healthcare is provided?
Preventive occupational healthcare primarily consists of the advice given by the occupational physician about the employee’s health in the context of their specific working conditions. Employees are not obliged to provide information about their health or to be examined. However, it is only possible to provide good occupational medical advice if a medical history is taken and an examinations has been carried out, which means gathering information about the employee’s medical history. Clinical examinations such as a hearing test or laboratory tests are often important, but always require the employee’s express consent. This applies for all preventive occupational healthcare examinations.
The matters dealt with and procedures for occupational medical consultations depend on the specific occasion, in other words the relevant occupational exposure. The German Social Accident Insurance (Deutsche Gesetzliche Unfallversicherung, DGUV) has published recommendations concerning the concrete steps to be taken during the medical history taking and clinical examinations and the matters to be dealt with in consultations about various kinds of occupational exposure.
Apart from these recommendations for occupational physicians, the current medical guidelines issued by Germany’s scientific medical societies form the basis for the consultations.
Is the advice given during preventive occupational healthcare limited to one occasion?
No. Since 2019 the Ordinance on Preventive Occupational Health Care has required all occasions for the provision of preventive occupational healthcare to be bundled in one appointment with the occupational physician (second sentence of Section3(3), third sentence of Section6(1) ArbMedVV). Furthermore, the occupational physician is supposed to record all working current and retrospective conditions and work-related hazards and take account of them during the interview. Preventive occupational healthcare may also entail other healthcare interventions.
The principle established by the legislature that preventive occupational healthcare should not be limited to single exposures, but looked at in the round, is referred to as the holistic approach. Background information and methodologies are set out for occupational physicians in Occupational Medical Regulation AMR3.3, Holistic Preventive Occupational Healthcare giving Consideration to all Working Conditions and Work-related Hazards (Ganzheitliche arbeitsmedizinische Vorsorge unter Berücksichtigung aller Arbeitsbedingungen und arbeitsbedingten Gefährdungen). BAuA is investigating the extent to which this approach has already been implemented in one of its research projects (F2522).
What is the outcome of preventive occupational healthcare?
The main outcome of preventive occupational healthcare is the oral advice given by the occupational physician. Based on what is known about the workplace and the employees’ health, the occupational physician will assess, provide information about, and advise on the interactions between these factors and the employees’ work. Employees’ questions or concerns about the workloads to which they are exposed and their own health can be clarified at the preventive healthcare consultation.
The occupational physician is able to give advice about the diagnostic, therapeutic, and prognostic aspects of a condition suffered by an employee that is connected with their work and, where appropriate, also refer the patient to a medical specialist for treatment. During the preventive healthcare consultation the employee’s attention can also be drawn to the prevention and rehabilitation services offered by the statutory pension, sickness, and accident insurance providers. Where necessary, employees can also be referred from preventive occupational healthcare to other kinds of medical care provided within the organisation, psychosomatic and psychotherapeutic consultations for instance. Employees will also be told about workplace health promotion schemes, such as nutritional advice or exercise programmes.
Should the preventive healthcare process lead to the conclusion that there is a justified suspicion of an occupational disease, the occupational physician has a statutory obligation to report this to the social accident insurance providers and/or the occupational safety and health authority of the federal state where the workplace is located. In this case, the employee will be advised about the situation.
Written findings or results concerning medical matters are only issued directly to employees and are otherwise subject to medical confidentiality.
Attestations of preventive occupational healthcare are important pieces of documentation for employees, supplying proof that they have been exposed to occupational hazards during a particular period of employment and that their health status has been recorded and documented by an occupational physician providing preventive occupational healthcare. Attestations of occupational preventive healthcare should therefore be retained, for insurance purposes for example.
The organisation also receives an attestation of preventive occupational healthcare. This merely confirms the fact that the consultation has taken place and the nature of the occasion (the specific hazard in the workplace, e.g. exposure to noise). Further details are regulated by Occupational Medical Regulation AMR6.4.
How often do preventive occupational healthcare consultations take place?
Where they are required (either optional or mandatory) by law, preventive occupational healthcare consultations are offered and/or conducted at regular intervals.
The timing of consultations is stipulated in Occupational Medical Regulation AMR2.1. Typically, the first consultation will take place threemonths before the employee takes up their new role, followed by another consultation twelvemonths after they start it and every thirty-sixmonths subsequently.
Who draws up regulations and advice on the delivery of preventive occupational healthcare in Germany?
The duties performed by the occupational physician when providing preventive occupational healthcare are specified in concrete terms by the Occupational Medicine Committee (Ausschuss für Arbeitsmedizin, AfAMed) in its Occupational Medical Regulations (Arbeitsmedizinische Regeln, AMRs) and Occupational Medical Recommendations (Arbeitsmedizinische Empfehlungen, AMEs), which reflect the state of the art of occupational medicine and well-founded occupational medical knowledge.
BAuA is responsible for the administration of AfAMed’s business. Information on AfAMed and all its decisions, regulations, and statements are published here. The Occupational Medical Regulations include AMR3.2, Preventive Occupational Healthcare (Arbeitsmedizinische Prävention), which defines the three areas of preventive occupational healthcare discussed above.
What is preventive occupational healthcare not able to do?
Preventive occupational healthcare is not able to replace technical (T) and organisational (O) protective measures. These always take priority over personal (P) measures (the “TOP principle”). Where applicable, however, the findings reached when preventive occupational healthcare is provided are to be used in order to introduce, review, or adapt technical and organisational protective measures in workplaces. Such measures may be implemented for the benefit of all the employees in a workplace or purely for particular individuals.
