title: [Qualitative research of contexts of occupational physician's advice].
abstract: OBJECTIVE
  No consistent procedure has been established for advice given by occupational physicians concerning scope of disease, criteria of diagnosis and laboratory data, and basis of judgment. The aim of this study was to identify practice-based contexts of occupational physician's advice.
  
  
  METHODS
  We interviewed 6 occupational physicians, and held focus group discussions (FGD) involving 19 occupational physicians, academic researchers, and clinical doctors. Scripts of the interview and FGD were coded to identify the contexts of occupational physician's advice. Additionally, to assure the generalizability of the proposed contexts of occupational physician's advice, we also conducted a survey to collect cases of advice, for which the fitness of the proposed contexts was confirmed.
  
  
  RESULTS
  Four contexts of occupational physician's advice were identified from interviews and FGD, and an additional context was detected through the occupational physician's survey, namely Type 1, work potentially affects a worker's health; Type 2, risk management and prevention of accidents relating to disease; Type 3, recommendation to visit a doctor (referral); Type 4, communication to the head of the department/supervisor; and Type 5, fit for work with appropriate adjustment of work environment and/or conditions. All 48 cases collected could be classified into one or more of these five contexts.
  
  
  CONCLUSIONS
  This study clarified that several contexts exist for occupational physician's advice in practice. The five proposed contexts reveal different responsibilities and judgments between occupational physician, worker, and employer. Understanding the contexts of occupational physician's advice is important for enhancing consensus-building between stakeholders.
authors.affiliation: Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka 807-8555, Japan. zenq@med.uoeh-u.ac.jp
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Fujino
authors.forename: Naoki
authors.initials: N
authors.lastname: Takahashi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Yokogawa
authors.forename: Kotaro
authors.initials: K
authors.lastname: Kayashima
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Tateishi
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Abe
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okubo
authors.forename: Koji
authors.initials: K
authors.lastname: Mori
mesh_terms: D000062:Accidents, Occupational / Q000517:prevention & control*; D000553:Ambulatory Care; D006801:Humans; D009784:Occupational Diseases / Q000209:etiology / Q000517:prevention & control*; D016272:Occupational Health; D054538:Occupational Health Physicians; D009786:Occupational Health Services; D012017:Referral and Consultation; D012308:Risk Management; D011795:Surveys and Questionnaires; D017132:Workplace