ALF MAGNE HORNELAND
As of 2019, medical schools do not offer much teaching on medical selection. This partly is the reason why many clinicians have an unclear understanding of why and how medical selection differs from the usual diagnostic, therapeutic and preventive practices most doctors know so well.
Research in the field is at best sparse. The end-points in today’s research studies do not give us much evidence for a better understanding of the selection process and its basis. Screening tests are widely used in enhanced PEME schemes, often without a justification and with a dubious evidence basis using cut-off points for therapeutic intervention as cut-off points for prediction of working ability at sea.
The literature is not abundant. There is some literature regarding medical selection for insurance purposes[1], on rehabilitation[2], on fitness to drive a car[3]. The ‘Handbook for seafarer medical examiners’[4] by professor Tim Carter is a practical handbook for the daily work as an approved doctor. It is based on the ILO/IMO Guidelines[5] and the author’s long experience as senior medical adviser to the UK Department of Transport, the UK Maritime and Coastguard Agency and as secretary to the ILO on producing the guidelines. Specific guidance documents are developed by some authorities[6] on how to make decisions in accordance with their respective statutory requirements.
We would very much like to know something of the likelihood for those medical incidents that could threaten safety for crew, ship and self for a period of maximum two years ahead, corresponding to the maximum validity period of a medical certificate. Published scientific articles only rarely offer such data.
At present, the heuristic way of decision-making is the regular one: Experience of what have worked in the past, and the doctor’s subjective assessment. We certainly hope that the future will provide us with scientific data that that enable us to reach decisions that are based more on evidence than on gut-feelings.
[1] Brackenride RDC, Croxson R, Mackenzie R. Brackenridge’s Medical Selection of Life Risks. Palgrave Macmillan. ISBN 978-1-349-72324-9
[2] Hobson J, Smedley J. Fitness for work. Sixth Edition 2019. The Medical Aspects. Faculty of Occupational Medicine (UK). Oxford University Press. ISBN: 9780198808657
[3] Carter T. Fitness to Drive. A guide for health professionals. Royal Society of Medicine Presss Ltd, 2006. ISBN 1-85315-651-5
[4] http://www.ncmm.no/publications/handbook-for-seafarer-medical-examiner
[5] ILO/IMO: Guidelines on the medical examination of seafarers, Preface. ISBN: 978-92-2-125097-5 (Web pdf)
[6] Guidance to regulations on the medical examination of employees on Norwegian ships and mobile offshore units. https://www.sdir.no/contentassets/fb935f4340b24c128b21a22edb9e3d58/veiledning-til-helseforskriften.pdf?t=1572421093968