INTRODUCTION Occupational medicine is a unique clinical specialty that links the direct clinical care of individuals with occupa- tional illnesses or injuries to workplace preventive efforts. 1 Thus, the occupational medicine physician has an oppor- tunity not only to impact the identified patient, but also to prevent disease or injury in similarly exposed coworkers. 1 As in other medical specialties, prevention efforts in occu- pational medicine can be categorized as primary, secondary, or tertiary. 2 The goal of primary prevention is to prevent injuries or the onset of disease, either by preventing expo- sure to workplace hazards or by preventing health effects due to exposure. Secondary prevention seeks to identify and treat asymptomatic individuals in whom preclinical disease has developed, before the condition becomes clinically appar- ent. Tertiary prevention seeks to prevent disability, disease progression, or death due to clinically apparent illness or injury. 3 Occupational and environmental medicine practition- ers can contribute to the prevention of occupational dis- eases and injuries in a number of ways. Examples of primary interventions that healthcare providers can initiate in individual clinical encounters include immu- nizations against occupational infectious diseases and provision of patient education about the effects of expo- sures sustained in the workplace and about ways to minimize those exposures. Examples of provider-based secondary prevention include blood lead monitoring and screening for asbestos-related malignancies. Examples of tertiary prevention initiatives that can be conducted in the clinical setting include treatment of occupational cancers or occupational asthma. In the workplace, primary preven- tive efforts include the substitution of less toxic chemicals and processes and ventilation systems to reduce exposure. Examples of secondary disease preventive efforts include workplace-based screening for occupational disease. Examples of workplace-based tertiary modifications in- clude job modifications to prevent reinjury and facilitate return to work. This chapter will describe approaches in the clinical setting to the primary, secondary, and tertiary prevention of occupational disease and injury, and will also provide an overview of Occupational Safety and Health Administration (OSHA)-mandated examinations for targeted populations, which provide the opportunity for secondary disease prevention. PRIMARY PREVENTION OF OCCUPATIONAL ILLNESS AND INJURY Primary prevention of occupational illness and injury is largely based on minimizing exposure to workplace hazards. While the healthcare provider may have limited ability to effect reductions of hazardous workplace expo- sures, there are a number of ways in which he or she can work towards primary prevention of occupational disease and injury in the clinical setting. These are described below. 1. Identification of occupational hazards by taking an occupational history, with follow-up to employers regarding hazard abatement By taking a careful occupational history, the healthcare provider can identify possible occupational hazards and can play an important role in prevention by communicat- ing with employers about reduction of hazardous expo- sures that are identified in the occupational history. Ultimately, the employer has responsibility for, and control over, whether or not appropriate preventive measures are employed in the workplace. However, the healthcare provider can function as an advocate for workplace safety in a way that individual workers cannot. For example, a study of predictors of employer-based risk reduction efforts for workers with upper extremity work-related diseases found that a physician recommending specific workplace exposure modifications increased the likelihood of their implementation. 4 However, despite the potential effective- ness of healthcare provider communication with employ- ers regarding workplace interventions, the healthcare provider should never communicate with an employer or other party without explicit permission from the patient, as such activities can result in severe consequences for some workers, particularly those in vulnerable populations. 2. Use of the sentinel health event approach When an occupational disease or injury is identified in an individual patient, it should be treated as an index case, or Chapter 58 Integrating Clinical Care with Prevention of Occupational Illness and Injury Robin Herbert, Jaime Szeinuk