A Publication of WTVP

After writing last month’s article about pre-employment physicals, I received many phone calls and e-mails, several regarding Department of Transportation (DOT) examinations. Many companies view these examinations as a necessary evil of the trucking industry. Given this, I decided to conduct an interview with Dr. Christine Cisneros, an occupational health physician, about these specialized physicals.

Why should an employer use physicians specializing in occupational medicine to perform DOT medical examinations?
“The heart of this question concerns what an occupational physician brings to the DOT physical examination that normally isn’t encountered with other health care providers. In addition to broad medical knowledge, successful DOT physicals require knowledge of the Federal Motor Carrier Safety Regulations criteria and a truck driver’s physical work demands. From a financial perspective, if drivers are mandated to have these physicals, why not get the most bang for the buck? When a trucking company’s liability rests in its drivers’ ability to drive safely, having the most thorough and competent examination makes good fiscal sense.”

Would you explain those physical demands?
“Commercial drivers do more than just drive. One colleague characterized professional driving as decision making under load. It’s primarily an avoidance activity performed under physically and mentally stressful conditions. There are basic medium to heavy physical demands placed on drivers, especially tractor-trailer drivers. An occupational medicine physician is aware of the work demands imposed on the typical DOT Driver.”

Why is an understanding of the physical demands so important for the physician?
“Driving a commercial vehicle has many hazards. In 1998, there were more than 41,000 motor vehicle fatalities with nearly 5,400 large trucks involved in those accidents. Truck drivers had a workplace fatality rate of 25.3 per 100,000 employees, the highest of any industry in 2001. Statistics like these make it prudent to ensure, through a medical certification process, that drivers are physically and mentally capable of driving safely.”

Who determined the medical guidelines for these physicals?
“They were instituted by the federal government as well as states. The Federal Motor Carrier Safety Regulations are printed on the DOT physical examination form for the use of the examining physician. But these are just guidelines. The prudent examiner is also knowledgeable about various other advisory panel guidelines.”

One of the significant issues in the employment arena is the aging workforce. How does this affect your DOT examinations?
“There are many concerns. For example, a common problem seen within the aging population is heart attacks. An understanding of the parameters that would assure a successful return to driving employment after a heart attack includes knowing the effects of recovery time and functional implications of cardiac tests. There are also cardiac medications that can impair the driver’s alertness. Again, it’s the work demands of the truck driver as they relate to these medical issues that are most important.”

What other insight can you give regarding the importance of the DOT examination?
“Any medical examiner has a thorough medical education. However, it’s an extended understanding of the DOT guidelines and a driver’s physical demands that allow the occupational health professional to relate any number of pulmonary, musculoskeletal, neurologic, cardiovascular, and even psychiatric and substance abuse disorders to the worker’s fitness for commercial driving.” IBI