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Occup Environ Med. 2007 November; 64(11): 786.
PMCID: PMC2078427

Fitness for work: the medical aspects, 4th edition

Reviewed by Robert L Maynard

Edited by KT Palmer, RAF Cox, I Brown. Oxford University Press, 2007, £45.00 (paperback), ISBN 978-0-19-921565-2

Reviewing a book edited by one's editor is a risk: in this case no problems were encountered! Fitness for work is a handbook for occupational physicians published for the Faculty of Occupational Medicine (Royal College of Physicians). As such it is the “official guide” and few occupational physicians will wish to be without a copy on their shelves or, more likely, on their desks. Seven hundred pages—25 chapters and approaching 100 pages of appendices—this book is detailed and not intended to be read from cover to cover except, perhaps, by faculty examination candidates.

I've read selectively. The chapters on the legal aspects of the subject are surprisingly easy going: the Acts (many) are leavened by case histories and legal precedents: G S Howard should be congratulated on making a potentially dull subject interesting. Dr C Harding has done as well in his chapter on ethics: the style is didactic but occupational physicians would be foolish to disregard Dr Harding's advice. More could have been said on the origins and basis of ethical constructs: references to texts providing such discussions are provided. I then picked out a series of chapters on medical problems. Johnson and Pitts provide a good account of eye disorders. I didn't know that 12% of the population lack stereoscopic vision—did you? This rises to 33% by age 65. Employment of the visually impaired is discussed and, again, illustrative case histories are provided. Hearing problems are explored by Ludlow and Hughes—a very helpful account. Balance control is described as a subject of delight to physiologists and discussed briefly. In reading this I was reminded of the late W B Mathew's remark: “There can be few physicians so dedicated to this art that they do not experience a slight decline in spirit on learning that their patient's complaint is of giddiness”. Quite so. Our editor and S B Pearson deal with respiratory disorders. A short but sharp review of means of assessing disability is provided with cogent advice on the testing and checking of apparatus. Asthma is considered in detail as is chronic obstructive pulmonary disease and, more briefly, interstitial lung disease and neoplastic disease. Knowing something of this area I scanned the references: the emphasis is on original papers and official advice rather than on standard works. Parkes, Seaton and Cotes, all authors of major works, will not find their books listed. This seems, to me, a fault: a handbook should provide guidance on where the reader might look for more advice, and a few notes on standard sources could have been provided.

The appendices deal with special problems: aviation, off‐shore working, seafarers; these will be of interest to those physicians working in these fields.

In conclusion this is a fine work—a handbook that will be wanted by all occupational physicians and a very important contribution by our faculty. Buy it.


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