Specialists in occupational and environmental medicine focus on recognizing, treating, and, most important, preventing illness and injury caused by workplace and environmental hazards. Only 1501 practicing specialists are board certified in occupational medicine (Ron Cornick, MALS, oral communication, December 7, 1993). However, annually there are an estimated 6 345 700 cases of work-related illness and injury among the 90 million Americans who work in private industry, and there are no comprehensive estimates of the prevalence of environmental illness.1 Patients may therefore present to physicians of any specialty.
Yet, too few physicians are adequately trained to recognize these illnesses. Brancati et al2 studied 94 patients admitted to the general medical wards of a university-affiliated veterans' hospital. They found that 62% of the patients had at least one probable occupational disease; of that subgroup, 68% had a history of an occupational exposure that was relevant to their disease. In contrast,