The doctor’s role in medical selection is different from the role in the usual way doctors handle their customers. The below table gives an impression on how different such work is.

Comparison of doctors’ different roles


Seafarer’s doctor

Company doctor

General practitioner


Compliance check




Fitness for work / absence of disease

Working environment / Occupational injuries and diseases

Individual’s health


Maximum two years ahead

Past, present and future

(Past), present and future


Medical selection in relation to requirements

Environmental factors affecting the worker

Medical treatment of illness and injuries


Contribution to the safety of the working environment

Prevent occupational injuries and diseases

Prevent and treat disease regardless of cause


Ship Safety and Security Act

Working Environment Act

Health and Care Act

The individual

A Candidate

An employee/worker

A Patient


Table 8: The roles of the medical examiner in medical selection, compared to other roles a doctor can have (Horneland AM).

Medical examiners approved by the NMA act as civil servants when carrying out their work as NMA seafarers’ doctors. They are checking whether the seafarer – today – meets the requirements, and assessing whether this is likely to be so for a maximum period of two years ahead. If not, they will limit the time of the medical certificate. The seafarer is a candidate showing up for his compliance check, and the result could be ‘pass’, ‘fail’ or ‘pass with restriction and/or limitation’. This is quite different from the role of a company doctor whose real ‘patient’ is the working environment or a general practitioner who is focusing on the patient’s individual health issues.

To give an example – an individual with a hearing loss, coming to three different doctors.

Seafarer’s doctor:

Company doctor:

General practitioner:

The AD will

·       Check the hearing capacity against the requirements


·       Issue a medical certificate if compliant

·       Issue a declaration of unfitness if non-compliant

The company doctor will

·       Check the medical record, to see if there is a trend in hearing loss

·       Ask if the worker is using hearing protection

·       Ask if there is much noise at the working place

·       Ask if there are colleagues that are suffering from hearing loss


·       Inform about the use of hearing protection

·       Carry out a noise level measurement at the working place

·       Call the colleagues for a hearing measurement

The General practitioner will

·       Check if there is cerumen in the auditory canal

·       Ask if the patient needs hearing aid

·       Ask if he want to be referred to a specialist


·       Refer to specialist if patients want so

·       Ask the patient to come back if he think the hearing deteriorates

It is obvious that the approach is very different. However, why is this important?

Sometimes there are legal barriers between what a general practitioner can reveal of information towards others, especially towards people outside the regular health service. This would apply in dealing with civil servants who is carrying out a lawful differential treatment or medical selection of workers. Having both roles, sometimes leads the doctor to trouble. He may not be entitled to know in another role what he knows in one role. Having also a company doctor role for the worker’s company, could lead to double trouble.