Abstract
The occupational and environmental history is fundamentally important to making the correct and timely diagnosis of any illness that may have resulted from a toxic exposure in the workplace, the household, or the general environment. In interviewing the patient with a potential occupational or occupational illness, it is important for the physician to ask questions that efficiently lead the patient into providing useful information about possible associations between the presenting illness and potential toxic exposures. A particularly useful and efficient construct for interviewing a patient about his or her occupational and environmental history is contained in the easy-to-remember mnemonic “WHACOS.” The components of the “WHACOS” mnemonic are as follows:
W—What do you do? H—How do you do it? A—Are the symptoms acute or chronic in nature? C—Are any coworkers, family members, or friends sick with the same illness? O—Do you have any hobbies, pets, or travel outside of work? S—Are you satisfied with your job? These simple questions can efficiently lead the patient into a useful dialog with the physician about occupational and environmental factors that can provide important clues about the etiology of an illness that may be related to a toxic exposure.
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References
Occupational and Environmental Exposure History form of the Department of Occupational Medicine, University of Western Ontario. http://instruct.uwo.ca/epidemiology/999/ExposureForm/exposureform.pdf. Accessed May 7th, 2012.
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Schuman SH, Mohr L, Simpson WM. The occupational and environmental medicine gap in the family medicine curriculum: five key elements in South Carolina: part II. J Occup Environ Med. 1997;39:1186–90.
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Appendix: Occupational and Environmental Exposure History
Appendix: Occupational and Environmental Exposure History
Patient Name: _______________ Medical Record Number: _______________
Date of Form Completion: ___________ Date of Birth: ___________
A. Current Occupational History
Are you currently employed?
Yes _____ No _____
If yes, what was your approximate date of hire? _________
Please fill out the following regarding your current job:
Name of Employer | Job Title | Job Description |
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|
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Describe your typical work shifts in a week (e.g. Monday 8AM-5PM, Tuesday 12noon-8PM etc.):
Monday________________
Tuesday________________
Wednesday________________
Thursday________________
Friday________________
Saturday________________
Sunday ________________
Can you smell the chemicals or materials that you work with?
Yes _____ No _____
Have you ever worked in a dusty environment?
Yes _____ No _____
Have you ever worked in a moldy or musty environment?
Yes _____ No _____
Do you ever get material from work on your clothes or skin?
Yes _____ No _____
Do you wash your hands with solvents in the workplace?
Yes _____ No _____
Do your work clothes get laundered at home?
Yes _____ No _____
Do you shower regularly at work?
Yes _____ No _____
Do you use protective equipment such as gloves, masks, respirators or hearing protectors at work?
Yes _____ No _____
Have you ever been advised to use protective equipment?
Yes _____ No _____
Have you been instructed in the use of protective equipment?
Yes _____ No _____
Is there smoke at the workplace?
Yes _____ No _____
Do you smoke in the workplace?
Yes _____ No _____
Do you eat at the work place?
Yes _____ No _____
Have you ever been off work for more than 1 day because of an illness related to work?
Yes _____ No _____
Have you ever changed jobs or work assignments because of health problems or injuries?
Yes _____ No _____
Has your work routine changed recently?
Yes _____ No _____
Is the ventilation system at your workplace adequate and working properly?
Yes _____ No _____
B. Hazardous Exposures at Work or Home (circle all that apply)
Animals | Extreme Heat/Cold | Nickel |
Arsenic | Fertilizers | Paints/Varnishes |
Asbestos | Fumes | Pesticides |
Benzene | Glues/Adhesives | Petroleum Products/Gasoline |
Beryllium | Grain Dust | Phosphates |
Biological Hazards | Isocyanates | Power Tools |
Cadmium | Latex | Sand/Stone Dust |
Chromates | Lead | Silica |
Cigarette Smoke | Lifting | Smoke |
Coal Dust | Loud Noise | Solvents |
Cobalt | Mercury | Vanadium |
Cutting Oils | Metal-Grinding Dust | Vibration |
Dust | Metal-Working Fluid | Wood Dust/Saw Dust |
Other:______________________________________________________________________ |
Are any co-workers exposed to any of the hazardous exposures listed above?
Yes _____ No _____
Are there any co-workers with symptoms similar to those that you are experiencing?
Yes _____ No _____
Is anyone in your home exposed to any of the hazardous exposures listed above?
Yes _____ No _____
Are there any family members with symptoms similar to those that you are experiencing?
Yes _____ No _____
C. Previous Occupational History
Please fill out the following table regarding past jobs, including temporary, seasonal, part-time and military employment
Employer | Date Started/Ended | Job Title/Description | Known Hazards |
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D. Environmental History
Community Environment:
Do you live close to any of the following? Check all that apply.
Heavy Traffic | Industrial Plant | Power Plant |
Waste Dump | Superfund Site | Construction Site |
Home Environment:
In approximately what year was your house built? ___________
Circle all that apply to your home.
Septic system | Central heating | Fireplace/Wood Stove |
Air humidifier | Central air conditioner | Gas stove |
Well water | Window air conditioner | Water leaks |
City water | Gas space heater | Other:_______________ |
Do you have a basement?
Yes _____ No _____
If yes, please answer the following questions:
Does your basement have a musty or moldy odor?
Yes _____ No _____
Does your basement have a water problem?
Yes _____ No _____
Has your basement ever flooded?
Yes _____ No _____
Is your kitchen stove exhausted to the outside from a range hood?
Yes _____ No _____
Is air from your bathroom(s) exhausted to the outside?
Yes _____ No _____
Is there mold growth on any of your bathroom walls?
Yes _____ No _____
Is there mold growth on any of your shower curtains?
Yes _____ No _____
Hobbies:
Circle all that apply.
Auto Body Repair/Restoration | Hunting | Photography |
Auto Mechanics | Leather Working | Sculpture |
Ceramics/Pottery | Masonry | Stone Work |
Electronics | Metal Working | Taxidermy |
Fishing | Model Making | Woodworking |
Gardening | Painting | Other: |
Do you use any solvents in any of your hobbies?
Yes _____ No _____
Do you do any soldering in any of your hobbies?
Yes _____ No _____
Do you have any pets?
Yes _____ No _____ If yes, what kind of pets? ____________________________
Have you ever kept birds as pets?
Yes _____ No _____If yes, what kind of bird(s)? ___________________________
Personal Exposures:
Do you currently smoke?
Yes _____ No _____
If yes, ________ packs/day for _________ years
Is there someone else in your household that smokes?
Yes _____ No _____
If yes, ________ packs/day for _________ years
Approximately how many drinks of alcohol do you have per week? __________________
Do you take any prescription drugs?
Yes _____ No _____
If yes, please list each drug that you take, the dose of each drug and how often you take each drug.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Do you take any herbal or vitamin supplements?
Yes _____ No _____
If yes, what do you take and how often do you take it?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Do you use recreational drugs?
Yes _____ No _____
If yes, what do you use and how often do you use it?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
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Mohr, L.C. (2012). The Occupational and Environmental History. In: Huang, YC., Ghio, A., Maier, L. (eds) A Clinical Guide to Occupational and Environmental Lung Diseases. Respiratory Medicine. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-149-3_2
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