Contents

• COMMITTEE ON THE ROLE OF THE PHYSICIAN IN OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
• A Note
• Preface
• Executive Summary
• CHAPTER 1. Introduction: The Nature of the Study
  • TARGET AUDIENCE AND FOCUS OF CONCERN
• CHAPTER 2. The Cause for Concern: An Analysis of the Problem
  • INCIDENCE OF OCCUPATIONAL AND ENVIRONMENTAL DISEASE
  • EVIDENCE OF NEED AND LESS THAN OPTIMAL PHYSICIAN PARTICIPATION
  • CHANGING SCENE OF MEDICAL CARE
  • INADEQUATE EDUCATION
  • LACK OF MEDICAL SCHOOL FACULTY
  • PRACTICING PHYSICIANS' ATTITUDES TOWARD HEALTH PROMOTION AND DISEASE PREVENTION
  • PROBLEMS IN PRACTICE
  • ECONOMIC ISSUES
  • LEGAL ISSUES
  • ETHICAL ISSUES
  • FRAGMENTED AGENCY RESPONSIBILITY
• CHAPTER 3. Goals and Interventions for Clinical Practice
  • INTERVENTIONS
  • THE MICROENVIRONMENT OF PRIMARY CARE OFFICE PRACTICE
  • INFORMATION: WHAT IS NEEDED?
  • INFORMATION: HOW TO PROVIDE IT?
  • THE MACROENVIRONMENT OF MEDICAL PRACTICE
• CHAPTER 4. Recommended Interventions in the Education of Future Physicians
  • EDUCATION OBJECTIVES FOR UNDERGRADUATE MEDICAL EDUCATION
  • EDUCATIONAL OBJECTIVES FOR GRADUATE MEDICAL EDUCATION
  • BARRIERS TO TEACHING OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
  • INCENTIVES FOR TEACHING OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
  • INTERVENTION STRATEGIES
• CHAPTER 5. Summary of Principal Recommendations
  • RECOMMENDATIONS TO FOSTER THE ROLE OF PRIMARY CARE PHYSICIANS IN PRESENT-DAY PATIENT CARE ACTIVITIES
  • RECOMMENDATIONS RELATED TO THE EDUCATION OF FUTURE PHYSICIANS
  • GENERAL RECOMMENDATIONS
• CHAPTER 6. Concluding Remarks
• References
• Appendixes
  • APPENDIX A Abstracts of Commissioned Papers
  • APPENDIX B Biographical Information on Committee Members and Consultants
  • APPENDIX C Glossary

The study was supported under contracts with the Environmental Protection Agency (Grant Nos. R813648-01 and R813648-01-0); the National Institute for Occupational Safety and Health, Centers for Disease Control; the National Institute of Environmental Health Sciences, National Institutes of Health; and a grant from the Charles A. Dana Foundation Incorporated (OPVT-8658-001). Additional support was provided by the National Research Council (NRC) Fund (ALOC-8897-001), a pool of private, discretionary, nonfederal funds that is used to support a program of Academy-initiated studies of national issues in which science and technology figure significantly. The NRC Fund consists of contributions from a consortium of private foundations including the Carnegie Corporation of New York, the Charles E. Culpeper Foundation, the William and Flora Hewlett Foundation, and the John D. and Catherine T. MacArthur Foundation, the Andrew W. Mellon Foundation, the Rockefeller Foundation, and the Alfred P. Sloan Foundation; the Academy Industry Program, which seeks annual contributions from companies that are concerned with the health of United States science and technology and with public policy issues with technological content; and the National Academy of Sciences and the National Academy of Engineering endowments.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee appointed by the members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.