New opportunities to improve occupational health in Italy [8] (multiple letters)

Sir We were surprised that Maurizio Manno and colleagues (May 25, p 1865),1 in their discussion of the parliamentary decision to improve safety and accident prevention at working sites, choose to move to an international stage a mere corporative controversy. The medico competente (competent doctor) is one of the highest paid jobs in Italian public health. The extension to specialists in forensic medicine and in hygiene and preventive medicine of the possibility to act as medico competente—ie, to officially be employed in the specialty of occupational hygiene, not occupational medicine—was a request that these two groups had advanced many years ago. We believe it has corrected an anomaly of Italian legislation, and is absolutely legitimate for the following reasons. Specialists in hygiene and preventive medicine have always dealt with safety and prevention, especially at living and working sites. In universities, the discipline of occupational hygiene is taught by these members of staff and not by the specialists in occupational medicine. Many specialists in hygiene and preventive medicine, and, similarly, many in forensic medicine, have already covered for many years positions of medico competente, which is permitted by law and satisfies employers and employees. The new law merely extends this possibility to younger specialists of both disciplines. In the specialty of occupational health there are progressively fewer typical pathologies of exclusively professional origin. The concept of work-related factors is expanding, meaning several groups of factors, from living habits to general environmental exposures, are involved in work-related disease. Therefore, the presence of specialists in hygiene and preventive medicine is historically acknowledged, and even indispensable to the occupational physicians themselves, who are traditionally dedicated to the diagnosis and cure of occupational diseases, for a better assessment of which factors determine modern occupational diseases. We believe that this explanation should be more than enough to legitimise the specialists in hygiene and preventive medicine as medico competente; the lawmaker, rightly, did not identify this role with that of specialists in occupational medicine because of his varied and multidisciplinary activities and the complexity of the different tasks he has to deal with, from epidemiological data processing, environmental risk analysis, training courses, to sanitary surveillance, and even to health management capability. Apart the different disciplinary, historical, and legal arguments previously illustrated, we anticipate that the association that includes most (around 4000) of the specialists in hygiene and preventive medicine nationwide, is available to cooperate with all the other operators in the public-health system, which includes occupational physicians, to adopt common initiatives for a continuous improvement of the medico competente role, and to promote better health and at working sites.