The Workplace Physician's Role in Suspected Occupational Disease

When a suspected occupational disease reaches the workplace physician

When a worker talks about a cough that has not gone away for months, sores on their hands or increasing ringing in the ears, this may be a suspected occupational disease. A suspected occupational disease usually reaches the workplace physician by one of three routes: the worker's own complaint, a change seen in a periodic examination compared with previous results, or similar complaints building up in the same department. Whichever route it comes by, the physician's next steps directly affect both the worker's health and the employer's obligations.

The definition of occupational disease, who makes the diagnosis and within how many working days the employer notifies were explained in our article on what an occupational disease is, diagnosis and notification. This article focuses on the role of the workplace physician from the moment of suspicion to the closing of the case.

The Regulation on Workplace Physicians and Other Health Personnel gives the physician clear duties on this: investigating the causes of work accidents and occupational diseases and recommending measures to prevent recurrence, investigating the relationship between health-related absences and health hazards at the workplace, carrying out the necessary examinations for workers with a diagnosis or preliminary diagnosis of occupational disease and ensuring their placement in suitable work, and repeating the examinations of other workers in the same environment (Art. 9).

Stage	Physician's task	Basis
Suspicion	Examination, exposure history, review of records	Physician Reg. Art. 9
Preliminary diagnosis and referral	Referral to a healthcare provider authorised by SGK	6331 Art. 14/3; Physician Reg. Art. 11/5
Informing the employer	Information needed for measures and notification; no medical detail	Physician Reg. Art. 11/1; 6331 Art. 15
Measures	Examination of other workers, recommending measurements, contribution to the risk assessment	Physician Reg. Art. 9
Follow-up	Placement in suitable work, return to work, records and annual report	Physician Reg. Art. 9

How is an exposure history taken?

An occupational disease diagnosis depends as much on the answer to "is it from this work?" as to "is there a disease?". The exposure history gives this answer. A good history combines what the worker says with the documents at the workplace.

Questions about the current job:

Exactly what work do they do? The work they actually do on site, not what is in the job description.
Which substances are they in contact with? Product names, safety data sheets, dust, noise, vibration, biological agents.
For how long, how many hours a day, on which shift?
Do they use personal protective equipment? Which, how often, is it suitable? If a mask is worn but its filter has not been changed for months, exposure is continuing.
Have there been unusual events such as leaks, spills or ventilation failures?

Questions about the past:

All previous jobs with their approximate durations. The worker can complete this list by obtaining their SGK service record from e-Devlet (the government's online services portal).
Non-work exposures: hobbies (woodwork, paint, metal), the home environment, a second job.
Smoking and similar habits; these affect the assessment especially in respiratory complaints.

Relationship in time: Did the symptoms appear after starting the job? Do they ease at weekends and during annual leave and worsen on return to work? This question is particularly helpful in diseases such as occupational asthma and contact dermatitis.

Comparison with documents: The history is assessed together with these records:

The pre-employment examination; the reference point showing the worker's condition when they started work.
Periodic examination and test results, such as hearing tests, pulmonary function tests and chest X-rays.
Workplace exposure measurement reports and the relevant section of the risk assessment.
Similar complaints by other workers in the same department.

Referral for occupational disease: prepare the file completely

Under Art. 14/3 of Law No. 6331 on Occupational Health and Safety, the workplace physician refers cases in which they have made a preliminary diagnosis of occupational disease to healthcare providers authorised by SGK. Under Law No. 5510, the final determination is made by the SGK Health Board by examining the health board report of the authorised healthcare provider and the supporting medical documents and, where necessary, reports showing the working conditions at the workplace. In other words, the quality of the referral affects the speed and accuracy of the diagnostic process.

The referral for occupational disease file should contain:

The preliminary diagnosis and reason for referral, with the physician's brief clinical assessment.
A summary of the exposure history: job, agent, duration, use of protection.
The relevant workplace exposure measurement reports and safety data sheets.
Pre-employment and periodic examination results, especially the comparison showing the change.
The relevant section of the risk assessment.

Under the regulation, the physician also cooperates with hospitals authorised to issue health board reports on occupational disease and works with the relevant units in the rehabilitation of the worker who has contracted the disease. Which institution to refer to is determined according to the current authorisation. Some of the documents are in the employer's file; so make sure workplace documents such as the measurement report and risk assessment are given to the physician in good time.

Informing the employer: notification while protecting confidentiality

The physician balances two obligations here. On one hand, they are obliged to observe confidentiality regarding the information in the worker's personal health file (Physician Reg. Art. 11/1); Law No. 6331 also requires health surveillance records to be kept confidential. On the other hand, the employer needs information to be able to take measures and to notify SGK in time of an occupational disease reported to it.

Shared with the employer	Not shared with the employer
That a worker has a suspected exposure-related health problem and has been referred	The medical details of the diagnosis, test results
Measures to be taken: measurement, ventilation, PPE, work arrangements	The worker's other illnesses, medications, family history
In which work the worker should not work, temporarily or permanently	Examination notes and the personal health file
That the examinations of workers in the same environment will be repeated	Other workers' individual results
The information and date of the occupational disease diagnosis needed for notification	The medical process leading to the diagnosis

Put the workplace physician notification process in writing in advance: to whom, by what means and when will diagnosis information be passed on from the physician, and who will make the SGK notification? The employer notifies SGK of an occupational disease reported to it within 3 working days of learning of it; this period can easily be missed through a correspondence delay between the physician and human resources. On protecting health data, see our article on employee health data and the KVKK (Turkish Personal Data Protection Law).

The worker is also informed. The physician explains to the worker in clear language why they are being referred, how the process will proceed and what they themselves can do; the worker's questions and decision are recorded.

Reviewing measures: a single case is a sign about a department

A suspected occupational disease is often a problem not of one person but of a working environment. The physician carries the suspicion over to measures through these steps:

Examine workers in the same environment. The health examinations of other workers in the environment where the worker with the preliminary diagnosis or diagnosis works are repeated. The physician determines the content of the tests according to the exposure.
Recommend measurement. Where necessary, the physician plans measurements in the working environment, submits them for the employer's approval and assesses the results from a health perspective. We plan workplace exposure measurements with authorised laboratories.
Have the risk assessment renewed. An occupational disease is one of the situations requiring the risk assessment to be renewed regardless of its validity period. The physician takes part in the assessment together with the OHS specialist.
Recommend placement in suitable work. For a worker found unfit to continue in their previous role, a suitable role is recommended and submitted for the employer's approval.
Shorten the examination interval. Where considered necessary, the periodic examination interval for that department is shortened.
Plan additional training. A worker who has contracted an occupational disease is given additional training before starting work on the causes of the disease, ways of protection and safe working methods.
Write recommendations in the approved logbook. Findings and recommendations are written in the approved logbook without medical detail and transferred to the action list.

For follow-up specific to the type of disease, see our articles on noise-induced hearing loss, occupational asthma and occupational dermatitis.

Occupational disease case management: records and follow-up

Good occupational disease case management does not end with referral. The physician keeps and monitors these records:

Case file: The history, examination, referral letter and the result returned from the health board are kept in the personal health file.
Return to work: After repeated health-related absences, or at the worker's request, an examination is carried out on return to work; if it is unsuitable for the worker to continue in their previous role, a suitable role is recommended. For the process, see our article on the return-to-work examination.
Department monitoring: The repeat examination results of other workers in the same department show whether the measures are working.
Annual evaluation: The physician evaluates work accidents and occupational diseases together with the OHS specialist; health surveillance results appear in the annual evaluation report.

On the employer's side, under Art. 14/1 of Law No. 6331, records of all occupational diseases are kept, and the necessary investigations are carried out and a report prepared. The 2026 base administrative fine for not keeping records is 33,326 TL, and for failing to notify in time 44,443 TL; you can see the amounts in the OHS administrative fines tool.

At businesses in Bursa and the surrounding provinces, Bursa Sistemer OSGB manages suspected occupational disease through these steps in our workplace physician services, and plans tests and the referral process with authorised healthcare institutions as part of health surveillance.

Frequently Asked Questions

Can the workplace physician diagnose an occupational disease?

The workplace physician makes a preliminary diagnosis and refers the worker to a healthcare provider authorised by SGK. For insurance rights, the final determination of occupational disease is made by the SGK Health Board.

Can the employer find out the worker's diagnosis?

The employer receives the information needed to take measures and make the notification: that there is a diagnosis or suspicion of occupational disease, which work the worker should not do and which measures will be taken. The medical details of the diagnosis and the personal health file are confidential.

Can a worker with a preliminary diagnosis continue in the same job?

The physician assesses the worker. If it is unsuitable for them to continue in their previous role, the physician recommends a suitable role and submits it for the employer's approval. Measures reducing exposure are taken without waiting for a final diagnosis.

Why are previous workplaces asked about in the exposure history?

Occupational diseases develop over years, and a symptom may stem from exposure in a previous job. Knowing previous jobs helps both with the correct diagnosis and with determining which job the disease is related to.