Time and knowledge barriers to recognizing occupational disease.

Traditionally, inadequate training has been considered the major barrier to recognition of occupational disease. A survey of 136 practitioners was conducted to determine which barriers were actually considered most relevant. The sample included three subgroups: primary care, occupational medicine-oriented, and Mexican. Four aggregate indices were derived: Knowledge, Time, Unpleasant aspects, and Importance. Inadequate Time was as important as inadequate Knowledge, whereas perceived lack of Importance and Unpleasant aspects were less relevant. Patterns among the subgroups were generally comparable. This study implies that training more occupational medicine specialists in increasing recognition is not sufficient unless specific strategies to overcome time constraints are also implemented. For example, emphasizing a "complete occupational history" may be counterproductive. Limiting histories to selected patients; use of focused, brief histories; and, perhaps, computer-based methods are needed.