Occupational Medicine and Health Insurance System

Skills Laboratory Activity

TOPIC 2: 7 STEPS OF DIAGNOSIS OF OCCUPATIONAL DISEASE
A.Y 2021/2022

General Objectives:
After completion of skill laboratory practice the student will be able to perform principle steps of 7 steps to
diagnose occupational disease.

Specific Objectives:
At the end of skill laboratory practices, the student will be able to perform the procedure of diagnosis of
occupational disease, including:
a. Confirm the Clinical Diagnosis
b. Determine the exposure in workplace
c. Decide association of exposure and the disease
d. Assign adequacy of exposure
e. Assess the individual risk factor
f. Assess the presence of other risk factors outside the workplace
g. Decide the diagnosis (occupational disease or not)

Syllabus Description
Sub Model Objective
After finishing skill practice of clinical examination, the students will be able to perform steps to decide an
occupational disease systematically

Expected Competencies
Student will be able to demonstrate process of analysis to determine an occupational disease

Methods
a. Demonstration
b. Coaching
c. Self-practices

Laboratory Facilities:
a. Class Room/Zoom Meeting
b. Scenario
c. Journal (about association of exposure and diseases)
d. Trainers
e. Student Learning Guide

Equipment
Case Scenario, Whiteboard, Board marker pen

Venue
Training room (Skills Laboratory)

Evaluation
a. OSCE
b. Point nodal evaluation
Reference
Permenkes No.56 Tahun 2016 tentang Penyelenggaraan Pelayanan Penyakit Akibat Kerja
Permenaker No.5 Tahun 2018 tentang Keselamatan dan Kesehatan Kerja
Checklist for 7 Steps of Occupational Diagnosis

Performance Scale
No Procedure
0 1 2
1 Say Basmalah
Step 1
2 Mention the appropriate clinical diagnosis

Step 2
3 Ask about the occupation of the worker chronologically and hazard faced by
worker (from all previous and recent jobs)
1. What work do you do now?
2. What jobs have you had since you left school?
3. Have you served in the Armed Forces? or
4. Have you worked overseas?
5. Do you have, or have you had occupational exposure to fumes,
chemicals, dust, loud noises, vibration, radiation or other occupational
hazards during your working history from the past until now?
6. Do you think that your illness is related to those hazardous exposure (s)?
4 Ask about the duration of each working process
1. Is it full time or part time?
2. How long have you been doing this job?
3. In what year and month did you start? (if possible)
4. How long is your working day (minute or hours)?
5. Do you do shifts and what is the shift rotation?
6. What is typical working day for you (number of days and time
(day/night)?
7. How often did you do the process in a working day? For how long each
day?
5 Ask what goods or product resulting from your work?
6 Ask determine substance used by workers
Key questions:
1. What materials do you work with?
2. Have you been told that any of these might make you ill, that is, are
hazardous?
3. Do you have a label, hazard sheet or hazard assessment?
4. How might you be exposed to this hazard?
5. Is there any factory substance list? Including the Material Safety Data
Sheet (MSDS) for each substance!
7 Ask about ways and work process
1. What tasks do you do?
2. Describe the processes and substances or material do you work with?
8 Ask about previous history of work accident/diseases
1. have you ever experienced an occupational accident in the past?
2. have you ever experienced or diagnosed having an occupational disease
in the past?
9 Ask about personal protective equipment used by workers
1. How is exposure controlled?
2. Do you wear special protective clothing or personal protective
equipment?
10 Conclusion step 2:
Determine which hazards might affect the patient's disease
Step 3
11 Summary of the Evidence based on literatures concerned with hazard-
disease correlation
Mention type of evidence-based sources (pathogenesis and pathophysiology
based on scientific literature, TLV/NAB based on government regulation,
 Performance Scale
No Procedure
0 1 2
Material safety data sheet, Employer previous Medical record, etc)
Step 4
12 Mention: Performing Qualitative measurement
observations on the way, process and working environment with
consideration of length of working time and working duration.

13 Mention: Performing Quantitative measurement

- periodic environmental measurement data/ambient monitoring related to
hazard
- biological monitoring data related to case and hazard
14 Conclusion step 4:
Determine the conclusion of the qualitative and quantitative hazard
measurement
Step 5
15 Ask about individual factors that contribute to the onset of the disease
1. Gender (based on epidemiologic data)
2. Age (based on epidemiologic data)
3. Habits (based on occupational anamnesis)
4. family history/genetic (based on occupational anamnesis)
resume from the anamnesis or ask the worker whether there is a similar
disease in the family?
5. history of atopic diseases
resume from the anamnesis of the clinical diagnosis whether Is there is any
atopic diseases such as asthma, allergic rhinitis, wheal skin diseases, etc of
the worker or his/her family
6. comorbidities.

16 Conclusion Step 5:
Resume from these findings whether there is/are comorbidities or individual
factor related or contributed to the case
Step 6
17 Ask other possibilities the presence of hazard outside the workplace
1. Do you have a second (or third) job?
2. What are your hobbies now and past times?
3. What daily activities or housework do you do?
4. Do any of these hobbies or activities bring you into contact with
chemicals, impure chemicals, breakdown products?
5. Are there any sources of environmental pollution in your area? For
example, factories, waste sites or contaminated sources of water
6. Smoking habits
18 Conclusion Step 6:
Resume from these findings whether there is/are external source of
hazardous materials or work procedures related or contributed to the case
Step 7
16 Decide the Occupational Diagnosis (Occupational Diseases or not)
17 Say Hamdalah
PENEGAKAN DIAGNOSIS OKUPASI (MEDICAL RECORD)

Langkah Diagnosis Pertama

1. Diagnosis Klinis
Dasar diagnosis (anamnesis,
pemeriksaan fisik, pemeriksaan
penunjang, body map, brief
survey)
2. Pajanan di tempat kerja
Fisik
Kimia
Biologi
Ergonomi
Psikososial
3 . Evidence Based (sebutkan
secara teoritis) pajanan di tempat
kerja yang menyebabkan
diagnosis klinis di langkah 1.
Dasar teorinya apa?
4. Apakah pajanan cukup
Masa kerja
Jumlah jam terpajan/ hari
Pemakaian APD
Konsentrasi pajanan
Lainnnya...........
Kesimpulan jumlah pajanan dan
dasar perhitungannya
5. Apa ada faktor individu yang
berpengaruh thd timbulnya
diagnosis klinis? Bila ada,
sebutkan.
6 . Apa terpajan bahaya
potensial yang sama spt di
langkah 3 luar tempat kerja?
Bila ada, sebutkan
7 . Diagnosis Okupasi
Apa diagnosis klinis ini termsk
penyakit akibat kerja?
Bukan penyakit akibat kerja
(diperberat oleh pekerjaan/
bukan sama sekali PAK)_
Butuh pemeriksaan lbh lanjut)?