[The occupational medicine specialist advice in support of the competent physician in the elaboration of the judgement of suitability to the job specification: evaluation method and analysis of case studies]

Introduction: Still today, one of the most problematic, qualified and awkward assignments for the occupational physician, also for its ethical and socio-economic involvements, is to provide for each worker a fitness judgment to a specific work task. Aim: The aim of this study is to describe and to support results and effectiveness of a "second level" expert advice in occupational medicine, among workers with a "problematic" judgment of fitness to work. Materials and methods: We considered 80 requests for a "second level" advice. They were all requested, during 6 years, to the same Occupational Medicine Unit (UOOML) of a single hospital in north of Italy by a single large metalwork company, following the art. 39 of the 8112008 legislative decree. Results: The study underlined the effectiveness of "second level" advices in evaluating the adequacy of worker's health conditions related to the specific occupational task. Moreover, this study contributed to develop an operative protocol to carry out a systematic and effective process when "second level" advices are addressed to an Occupational Medicine Unit (UOOML). In particular, our operative proposal suggests, as a key point in the assessment process, a careful visit to the occupational environment, to directly study each single task and to deepen the needs of each single occupational emplacement.