Refused hernia check

tbodnar1

Refused hernia check

Post by tbodnar1 » Tue Feb 15, 2011 9:25 am

Some male patients refuse the groin exam when a female NP or PA examines them. The examiners write "refused exam" and complete the Medical Examiner's Certificate stating the driver is qualified. I don't agree with this practice. Any opinions?



Robert Swotinsky MD
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Re: Refused hernia check

Post by Robert Swotinsky MD » Tue Feb 15, 2011 11:25 am

The determination of medical qualification is left to the medical examiner's judgement, subject to the physical standards in the regulation and, to a lesser extent, FMCSA guidelines. Neither the regulations nor guidelines require a hernia check or address refusal to have a hernia check. One could make a reasonable argument that the hernia check is usually if not always irrelevant to the determination of medical qualification.

PAcollector

Re: Refused hernia check

Post by PAcollector » Tue Feb 22, 2011 2:54 pm

Are the drivers refusing the exam shortly after providing a sample for drug testing? When I encounter resistance to a hernia check, I occasionally find that they are hiding the container they used to provide a substituted sample.

Jamads

Re: Refused hernia check

Post by Jamads » Fri Nov 15, 2013 5:37 am

I refused my hernia test and yes it was after I gave a urine sample but no that urine sample is not for drug testing. Most places don't require that since that test has been found to be unnecessary. The "sports hernia exam" hasn't even been required since the 2008-09 NCAA manual came out for school students. Also they don't check women vaginally for hernias at a dot so why should a man be forced to expose himself and feel molested?

occmedpac

Re: Refused hernia check

Post by occmedpac » Fri Nov 15, 2013 8:49 am

On the standard DOT / FMCSA approved medical history and physical forms, the DOT medical examiner is advised to check for genito-urinary and abdominal hernias.
The DOT medical examiner can then make the medical determination as to whether the driver is fit for duty if he/she has a hernia (reducible vs incarcerated).
If a driver refuses a part of the examination that the medical examiner deems relevant and necessary, then I feel that the examiner has the right to withold medical approval.

Dr Jeff

Re: Refused hernia check

Post by Dr Jeff » Fri Nov 15, 2013 9:21 am

No one feels "same sex" examination is in order with these refusals?

jmaslanko

Re: Refused hernia check

Post by jmaslanko » Fri Nov 15, 2013 9:38 am

It should be remembered that the driver must note on the health history section of the Medical Examination Report if he/she has had any illnesses or injuries in the last 5 years. He'd be in violation of DOT regulations if he didn't disclose any information relevant to a hernia. His certificate would be invalid, and he could face some adverse action from his employer.

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Re: Refused hernia check/inaccurate completion of health his

Post by Robert Swotinsky MD » Fri Nov 15, 2013 10:02 am

FMCSA has this FAQ on its web site:
1. What happens if a driver is not truthful about his/her health history on the medical examination form?

The FMCSA medical certification process is designed to ensure drivers are physically qualified to operate commercial vehicles safely. Each driver is required to complete the Health History section on the first page of the examination report and certify that the responses are complete and true. The driver must also certify that he/she understands that inaccurate, false or misleading information may invalidate the examination and medical examiner's certificate.

FMCSA relies on the medical examiner's clinical judgment to decide whether additional information should be obtained from the driver's treating physician. Deliberate omission or falsification of information may invalidate the examination and any certificate issued based on it. A civil penalty may also be levied against the driver under 49 U.S.C. 521(b)(2)(b), either for making a false statement of for concealing a disqualifying condition

While FMCSA can take action against a driver who deliberately falsifies his/her long form (health history), I don't think the medical examiner can do so. Accurate completion of the health history is not among the medical qualification standards. Inaccurate completion of the health history is thus not a medical basis for withholding certification. Instead, it is reasonable for the medical examiner to delve more deeply if there appear to be inaccuracies. For example, the medical examiner may want to contact the driver's treating physician for records.

It is certainly in FMCSA's prerogative to take action. For example, if a driver has a history of seizures, takes seizure meds, and doesn't identify this on the long form and then crashes a truck, FMCSA will likely prosecute the driver for deliberate omission of information. I don't know of a proactive way for the medical examiner to facilitate this, other than calling FMCSA to report on drivers who fill out history forms incorrectly. And, how would the ME know if it's deliberate or not?

An employer may, as a matter of policy, refuse to hire someone who provides an inaccurate health history. In most cases, the employer would become aware of such inaccuracy only if the medical examiner recognized and highlighted it on the long form, which typically goes to the employer.

drjchill

Re: Refused hernia check

Post by drjchill » Fri Nov 15, 2013 1:06 pm

First, THANK YOU Dr. S, this is a wonderful site.

I often deal with these issues by trying to be objective/consistent - I use the Official Disability Guidelines to generate restrictions. The recommended restriction for an inguinal hernia, according to ODG are:

Capabilities & Activity Modifications for Restricted Work:
Clerical/modified work: Lifting and carrying not more than 5 lbs up to 3 times/hr; pushing and pulling up to 10 lbs 3 times/hr; no handling of heavy machinery; driving car up to 2 hrs/day.
Manual work: Lifting and carrying not more than 20 lbs up to 10 times/hr; pushing and pulling up to 35 lbs 10 times/hr; limited handling of heavy machinery restricted by physical effort involved; driving car up to 2 hrs/day.

Does a truck driver's activies exceed the the recommended restrictions?
Does a truck driver need a restriction if operating a truck or doing non-driving tasks?

Checking for a hernia is a "quick and painless" standard medical exam procedure which might prevent significant morbidity.

Just my limited opinion.

Jamads

Re: Refused hernia check

Post by Jamads » Mon Nov 18, 2013 1:24 am

I believe they should start checking women for hernias just like they check men! The vaginal hernia exam is a very important test I believe and just as important for them to be checked for men to be checked. If they don't feel it's important for women, then it shouldn't be important for men either! Btw no I'm not kidding, I've been doing research about female hernias and allot of them have been missed because this exam isn't done, and when women are checked many come out of the doctors office feeling violated.

Dr. Metzger said that an abdominal exam in the standing position sometimes reveals a subtle bulge. But more often these hernias can be neither seen nor felt, and a correct diagnosis relies mainly on a vaginal examination. The pelvic muscles are often tense and tender, and the patient’s pain can be reproduced by pressure on the internal inguinal area, she said.

A version of this article appeared in print on May 17, 2011, on page D7 of the New York edition with the headline: In Women, Hernias May Be Hidden Agony.
Right from the New York Times!

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