TABLE OF CONTENTS Clinicians have long sensed that workplace stressors can have a profound impact upon their patients' health. In 1958 Drs. Henry Russek and Burton Zohman published a seminal paper from their own medical practice, identifying "occupational stress and strain" as the factor which most sharply distinguished their young patients with ischemic heart disease from a group of healthy referents. Their analyses relied upon descriptive data obtained from patient histories. In the first international workshop on Occupational Cardiology, held in 1988 in Udine, Italy focusing upon return to work for patients after acute myocardial infarction or revascularization, Dr. Giorgio Maisano, the chairperson, eloquently summed up the challenges faced by clinicians: to offer the patient a style of life and of work that protects both his or her health and right to be productive. Dr. Maisano insisted that in order to achieve the aforementioned goal, understanding of the job and the work environment, in addition to a functional evaluation of the patient, is absolutely essential. In other words, taking this approach, when clinicians are called upon to make a judgment about the work fitness of their patients, they should also ask the fundamental question: is the work environment fit, or conducive to health?
In this chapter, we will present a series of pedagogically constructed clinical cases that address this challenge. These are not based on any individual patient . We begin...
