Quality of periodic health examination and professional ethics

Abstract

 The practice of health examinations originated from 19th-century screening for communicable diseases, and grew popular among health-conscious people. In Japan, health examinations are stipulated by legislation and are now also used for health counselling regarding cancer and cardiovascular diseases. Scientific studies have repeatedly noted the lack of evidence that multiphasic health examinations reduce mortality. However, despite the dubious overall benefits, medical providers, public servants, and everyday citizens worldwide typically expect such examinations will promote health. Examinations intrinsically imply an assessment of one’s healthiness; however, proposed methods of evaluation have not been widely unified. Health examinations performed as a part of occupational health should function as either surveillance of human exposure and/or effects of the working environment or screenings for occupational diseases. Surveillance analyzing biological specimens can be referred to as biological monitoring. This should follow the guidelines issued by the International Labour Organization and by academic organizations, which recommend less-invasive methods and comprehensive evaluations with reference to the results of assessment of the working environment. If suspect symptoms or other signs are noted among workers, the workers’ relationship with their workplace and/or work itself must be carefully investigated so as to never overlook occupational diseases. Pre-employment health examinations should not be used in the recruitment process. All relevant personnel should work with due consideration of the bioethical principles of safeguarding autonomy, promoting and protecting welfare, and maintaining fairness for examinees throughout the processes of planning, execution, reporting results, and personal information control. It is particularly necessary to establish a system for obtaining consent when requiring tests that are not legally required. Medical personnel specializing in health examinations should participate from the planning stage in pursuit of continuous improvement; giving advice for applying the latest scientific knowledge, assuring the quality of testing, and facilitating appropriate use of the results acquired.