Abstract
This paper examines the evidence base for the use of pre-employment/pre-placement medical examinations. The use of pre-employment examinations is often driven more by cultural practices than evidence. There is a lack of evidence on their effectiveness in preventing health-related occupational risks. Hypertension screening is highlighted as a common pre-employment practice for which there is no standardized criteria to use to determine fitness for work. There are inherent problems in screening for psychiatric disorders and substance abuse as well as potential for racial bias and other unintended negative effects. This paper questions the economic case for this practice and also expresses concerns about paternalism related to identified risk factors. Health assessments should only be included when appropriate to the task environment and the general use of pre-employment exams and drug screening should be eliminated. Generally, a health assessment by questionnaire should suffice. Occupational health providers should advise against the application of physical or mental standards that are not relevant to fulfilment of the essential job functions. Consensus development regarding best practice, as well as consideration for acquiring outcome data related to pre-employment practice, is recommended.