Continued employment of individuals partially disabled by heart disease

Continued Employment of Individuals Partially Disabled by Heart Disease JOHN J. THORPE,

New York,

HE PHYSICIAN

T

points

return the

of

in industry

reference

of a cardiac

patient’s The

second

tional

demands

to work.

and

is the

physical

there may be a number

tory

influencing

factors

motivation,

his final

age,

home

of management,

duration

them

is

and

Where

job.

decision, and

employees,

120 mm

such

As the of

he

reviews

doctor the

patient’s

medical

to

categorize

him

family

following

groups

diagnostic

record

This

prognostic

is

a

return

though

experience

to productive

significant (b)

our

work,

changes

recurrent

about

in job

half

85

cent

of them

with

various

series may Of

between

vary

those

55 and

Approximately

between

who

survive

70 per half

cent

will

rates

ually

15 and

70 per

a given

attack

return

require

(c)

Congestive Heart Failure:

nificant

As

job

About

55

per

most of them

with

sig-

severe

is aware

than

responsibilities)

the doctor’s not

they work

the disability hopes

high. that

of suc-

This

difficulty

problem

the

with strong

whom

Where

are

that

placement

with

not

of re-

has a much

Employees

physical

emotional

us-

or a sec-

is almost

as

to treatment.

far

as the

cerned, fairly edge

the

on returning

In special

by:

to 348

the

job

of the job physician

from

his general

a man

the doctor’s supervisor,

of what

Although

cases he may

are

plant

environment

requires.

management,

(a) Congestive Heart Failure: ‘Two out of three

picture

of the plant

decision

demands

modern

accurate

assignment

HEART DISEASE

is manifested

six months,

means

because

(i.e., family

rehabilitation

and

will

ENERGY DEMANDS OF THE JOB

restrictions.

HYPERTENSIVE This

to work,

incentives

resistant

to work. some

or

60 per cent

them

of age

successful

this age level. ties to the group

ondary

for

doctor

55 years

for

of job

be less of a problem.

cessful

change. cent will return

chance

exceeds

assignment.

Myocardial Infarction: Mortality

cent.5

will

dis-

per

areas

treatment

half

regular

the

under

or social

an-

appropriate

activity. addition,

economic

controllable

In

order.

over

be interdicted.

Over

stricted

better

treated

work.

by:

to do their

individual

by:

to

to work.

one above

Coronary Insujiciency: Properly

(a)

of

to regular

in unprotected

may

respond

In

HEART DISEASE

is manifested

climbing

be able one

: 1-4

ARTERIOSCLEROTIC

gina

and

Hg,

is manifested

return

into

most

is consistently

Congestive Heart Failure: About

(a)

CLASSIFICATION

the

tends

work,

all return

pressure

vehicles

This will

AND

productive

RHEUMATIC HEART DISEASE

his

physician. DIAGNOSIS

diastolic

driving

attitudes

and

to

restrictions.

Dzjkse Symptoms Ascribed to Essential Hy-

(b)

emo-

of disability,

return

with

pertension: Practically

health

of contribu-

environment, fellow

One

York

patients

the

regular

In addition,

New

major

current

of the employee’s

as the patient’s

two

considering

patient

diagnosis

status.

has

in

M.D.

the

to work

advice

con-

has

a

knowla given ultimate

belongs

to

is influential.

go to the job

site, talk

and

work

observe

in

THE AMERICAN JOURNAL OF CARDIOLOGY

Thorpe progress

to be sure his estimate

some

instances

been

done

in the plant

by an expert

field,

who

has

carried

required

job

analysis

actually

in different

ing table,

studies

laborer’s

illustrates job

may

have in this

out the tasks The follow-

assignments.

for example,

of a general

In

is correct.

oxygen

consumption

for many

so-called

labor-

ing jobs is only two or three times resting levels except

for very short

latter demands patients.

periods

can be handled

of time.

These

by many cardiac

the demands

at the Baton

Rouge

Refinery.

DEFINITION W JOB DEMANDS (L MAN’S CA-CITY TABLE

PEWiTS

PROPER PLACEMENT

I

Physical Demands of General Laborers’ Jobs

-

I

Hours per day

Minimum

MaxiITXUll

Average

-Walking Ascending stairs, etc.

1 0

4 l/2

2 ‘I6

~~ Lifting and carrying

1 to 25 lb 26 to 75 lb Over 75 It

0 0 0

8

3 ‘/z

5 1

Physical demands and job analysis form

Fig. 1.

l/10

Physical TABLE

capacities

matched

II

Capacities in Hours/Day Needed to do 90 Per Cent and 50 Per Cent of All Manual Labor Jobs (Skied and Unskilled Included)

by

against

the

use

Figure

of analytical

The Physical of effort Analysis

Standing Walking Ascending stairs or ramps Climbing (use of arms and legs) Lifting up to 75 lb Carrying up to 75 lb

4

6 3 1

11/Z ‘/j

1

‘/5

21/z 1

‘/5

process, The

systematically

of a given

studies have been of great educational

climb,

etc.,

without

nosis,

etc.

These

foremen

value in demonstrating less physical Table

that many tasks require

effort than their titles would imply.

II shows the capacities

in hours per day

needed to do 90 per cent and 50 per cent of all manual labor jobs at the same plant. More exact studies of energy demands for various kinds of work have been carried Hellerstein confirm MARCH,

and his group at Cleveland.6

the above observation 19.58

out by

by showing

They that

of specific types

Physical

are

doctor’s

ability

disclosing useful

and

Capacities esti-

to walk,

diagnosis, guides

lift,

prog-

for

line

who may have to move men from day

to day for optimum on a research

one

flexibility could

as estimated

In a number clinical

of Levenson it to the

by Hellerstein’s

same

and

job

thing

the cardiac and his coenergy

de-

technic.

of cases, no matter

information

available,

and efficiency.

do the

basis by measuring

reserve by the method mands

in

mechanical,

lists the

patient’s

workers7 and comparing Such

jobs

as shown

form is a re-statement

observation

jobs.

Presumably,

1

forms

Demands

for various

semi-technical mate

may be

of various

1.

of the Job Analyst’s

Hours per day

of the individual

the demands

how much

evaluation

the only way to determine

are

whether

or not a man can work is by a trial on the job. Sometimes this must be done in the face of minor angina1 attacks or mild dyspnea. Although some risk is involved, trial at work is indicated if the health situation is stabilized, if the patient is anxious

to work,

has a realistic

view of his

Employment

350 own situation,

uses medication

the occurrence normal

intelligently,

of symptoms

nonoccupational

of Partially and

is as related

effort

to

as it is to job

Disabled technical

At times the capacities the demands plant.

of a number

Certain

complicate

other

particular

variables,

be manning unit

with

of another

in certain

however,

and

restricted

they may feel unable

outlined

In some cases jobs prescribed

may

men.

people.

The

be utilized the overall

In such a situation

to accept

under the conditions

may

which

be already Placement

conflicts

of the private

with

the individual

by the doctor.

sions with the industrial work situation

the extent

of agreeing

In addition,

patient and

SUMMARY

Successful placement and

the

problems and

requirements of employee

co-worker

fit the limitations

must

between

and his colleagues

cardiac

may

exist

the patient’s

problems

but not

plant ployee meet cases.

job.

motivation, require

respect

tactful

group

and understanding

the physician in private

enthusiastic

Special

management

in industry

practice

to insure

participation.

REFERENCES The

1. THORPE, J. J.:

optimum

time for return to

bilities.

on the proposed move. on placement.

situation.

between

If rapport

the

additional

plant

two

in

Esso

anx-

solve

installations

Representatives

and

Medical

intervals

medical

advice

and

line supervision,

Relations at frequent

conflicting

cannot

the

these

One method which has

Committee.

management,

is not

doctors,

uncertainty

physician

successful

may have He may

with the plant physician’s

may be torn between

The

his

rules which

of the

Placement

to

of his capabilities

of

attitudes

occupied

by able

of the cardiac in industry

depends on skilled evaluation

there may be seniority

side issues unilaterally. been

by discus-

in which the

work following various major cardiovascular

bearing

develop

iety. The

physician

themselves.

not agree completely estimate

Cooperation

is secured

is more fully explained.

Mutual

The attitude of the family physician

established

and

to penalize

call for union agreement an important

management discussed

often resolved.

handling.

of the

the cardiac’s

are

physician

mean that these men have to be moved to less Co-workers may sympadesirable positions. thize

involving

interests

of jobs on a

affect

of the operation.

the

Problems

employee

Management

a number

may

match

within

man who cannot

emergencies

efficiency

bodied

of jobs

successful placement.

may already addition

of the individual

terms without disclosure of confidential

information. apparent

effort.

Cardiacs

is

the

of top the Em-

Departments

to review

problem

story is presented

in non-

2.

Zndust. Med.

HANSEN, H. and WEAVER, N. K.: hearts at

work.

disa-

25: 329, 1956.

J. Louisiana

Arteriosclerotic

M.

Sot.

107: 63,

1955. Cardiovascular disease in industry. 3. FRANCO, S. C.: Zndast. Med. 20: 308, 1951. The cardic can work.

4. FRANCO, S. C.: 23: 7, 1954. 5. SCHNUR, S.

Mortality

infarction.

I.

Indust. Med.

rates in acute myocardial

The normal yearly variations and

the effect of hospital admission policy.

Med.

Ann. Znt.

39: 1014, 1953.

6. HELLERSTEIN, H. K. and FORD, A. B.: Rehabi!itation of the cardiac patient. J.A.M.A. 164: 225, 1957. 7. LEVENSON, R. M., R. A. Comparison

SPARKMAN, D.

R.,

and BRUCE,

of disability and exercise toler-

ance of cardiac patients referred for evaluation of work

capacity.

Session, Am.

Presented

Heart

Assoc.,

at

29th

Cincinnati,

Scientific October

28, 1956.

THE AMERICAN JOURNAL OF CARDIOLOGY