石綿暴露工作者的職業健檢：職業醫學專科醫師的觀點

Occupational health examination of asbestos-exposed workers: viewpoints of occupational health physicians

目標：職業健檢機制的制度缺失之一，為特殊健檢的對象僅限在職者，因而難以早期偵測 潛伏期漫長的職業病。有鑑於職業醫學專科醫師（職醫）在職業健檢制度中扮演重要角色，本 研究以石綿相關疾病為例，探討職醫對於石綿作業工作者離職後健檢機制必要性、可行性與影 響的觀點。方法：研究者在2017年1月至8月間個別訪談15位職醫，訪談主題為：(1)對於目前石 綿作業特殊健檢機制的看法，(2)對於建立職業石綿暴露工作者離職後追蹤檢查機制的看法。 結果：受訪者都同意現有的職業健檢制度無法對職業石綿相關疾病發揮提早偵測的功能，因此 有必要改善。然而，受訪者對於建立石綿職後健檢機制持有疑義，可歸納為以下五個面向： (1)界定石綿暴露工作者的困難，(2)確認石綿暴露的困難，(3)缺乏合適的篩檢工具與專業判讀 人員，(4)缺乏明確的財源機制與配套措施，(5)可能引發道德危害疑慮。結論：受訪的職醫皆 同意政府應針對石綿暴露工作者建立職後健檢機制，並同意其他可能導致職業病罹病風險的職 業危害也應比照，然而在執行層面上之制度設計與配套措施，仍需就上述問題作進一步研商。

Objectives: One of the many shortcomings of the current occupational health examination (OHE) system in Taiwan is that only on-the-job workers are eligible to participate, making it difficult for the early detection of workers who develop occupational diseases with long disease latencies. We used occupational asbestos-related diseases (OARDs) as an example to explore the opinions of occupational health physicians (OHPs), who play important roles in the OHE system, regarding the necessity, feasibility, and potential impact of post-exposure OHEs involving asbestos-exposed workers. Methods: Fifteen OHPs were interviewed individually during the period from January to August 2017, with questions on the following two themes: (1) opinions about the current OHE system for asbestos-exposed workers; and (2) opinions on the establishment of post-exposure OHEs for asbestos-exposed workers. Results: All of the interviewees agreed that the current OHE system fails to detect OARDs, thus reforms are needed; however, the interviewees had concerns regarding the establishment of a post-exposure OHE system, which were summarized in the following 5 dimensions: (1) problems of identifying asbestos-exposed workers; (2) difficulties in verifying asbestos exposure; (3) uncertainty in choosing a suitable screening tool and in ensuring qualified personnel; (4) lack of financial resources and administrative support; and (5) problems of moral hazards. Conclusions: All of the interviewed OHPs agreed that the establishment of a post-exposure OHE system is needed, not just for asbestos-exposed workers, but for workers exposed to other types of hazardous substances with long disease latencies. To design the system and its implementation procedures, more discussions are needed, especially with respect to the aforementioned issues.