A specialised clinic for occupational and environmental medicine within a university hospital

Introduction
Various studies indicate that exposures at work contribute substantially to the burden of disease. However, in Belgium, as in many other industrialized countries, occupational physicians have essentially a preventative role and they are only rarely involved in the curative sector. On the other hand, physicians working in the curative sector are generally unfamiliar with occupational medicine and they have difficulties recognizing past or current occupations as a cause or determinant of disease. Since 1988 a specialized outpatient clinic, currently manned by three occupational physicians, has been in existence within the division of pneumology of the University Hospitals of Leuven in order to diagnose occupational or environmental health problems.

Methods
In this retrospective descriptive study, we included all 733 patients referred for the first time to our clinic during the period 2003-2008. We extracted the following information from their medical files: socio-demographic data, referring physician, past and previous occupation, medical data (primary illness and co-morbidity), role of occupation and specific causal agent(s).

Results
More than 75% of the patients presented with respiratory diseases, mainly asthma (allergic asthma and irritant-induced asthma, including reactive airways dysfunction syndrome), but also asbestos-related disorders, interstitial lung disease and lung cancer. About 22% had non-respiratory disease: skin disease, neurologic conditions (especially chronic solvent encephalopathy), functional somatic syndromes (including multiple chemical sensitivity). Patients were referred by specialists (mainly pneumologists), occupational physicians, family doctors and, occasionally, by themselves.

Discussion
This outpatient clinic has an almost unique position in Belgian curative medicine. From an initial focus on occupational respiratory disease, it has evolved to include also other medical conditions and the scope could be widened to other diseases, such as musculoskeletal disease. The integration within tertiary hospitals of physicians with a specific expertise in occupational medicine contributes to a better recognition of work-related diseases.