open access

Vol 63, No 2 (2012)
Original article
Published online: 2012-09-03
Submitted: 2013-02-18
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Do Approved Doctors and Medical Referees in the UK agree when assessing a seafarer’s fitness?

Isam Rustom, Tim Carter
International Maritime Health 2012;63(2):71-77.

open access

Vol 63, No 2 (2012)
MARITIME MEDICINE Original articles
Published online: 2012-09-03
Submitted: 2013-02-18

Abstract

Introduction. The seafaring industry remains a hazardous occupation that requires sophisticated systems of risk and fitness assessment. This study aims to investigate the extent of agreement between Approved Doctors (ADs) and Medical Referees (MRs) when they assess a seafarer’s fitness.

Material and methods. Between 2003 and 2009 a total of 232,878 seafarer medical examinations were carried out by ADs, of which 465 were considered by the MRs because the seafarer appealed against the AD’s decision. The extent of agreement between ADs and MRs was studied.

Results. Two hundred and sixty-eight (58%) cases seen by the ADs were classed as category 4 “permanently unfit”; the referees only placed 85 (18%) of them in this category. On the other hand, 252 (54%) cases seen by the MRs were classed as category 2 “fit with restrictions”, while the ADs had only placed 111 (24%) in this category. The overall agreement between the assessors (AD vs. MR) was poor (Kappa K = 0.18).

Discussion. For cardiovascular diseases and for mental ill-health, access to additional information by the MR was the commonest reason for changing the fitness category, but for all other conditions factors such as the experience and knowledge of the MRs or their different interpretation of the standards were the most frequent reasons for a change to fitness category or to restrictions.

Conclusions. This study found that there was poor agreement between the AD’s decision and the subsequent MR’s decision regarding the fitness of those seafarers who decided to appeal against the AD’s initial assessment. The reasons for this are considered.

Abstract

Introduction. The seafaring industry remains a hazardous occupation that requires sophisticated systems of risk and fitness assessment. This study aims to investigate the extent of agreement between Approved Doctors (ADs) and Medical Referees (MRs) when they assess a seafarer’s fitness.

Material and methods. Between 2003 and 2009 a total of 232,878 seafarer medical examinations were carried out by ADs, of which 465 were considered by the MRs because the seafarer appealed against the AD’s decision. The extent of agreement between ADs and MRs was studied.

Results. Two hundred and sixty-eight (58%) cases seen by the ADs were classed as category 4 “permanently unfit”; the referees only placed 85 (18%) of them in this category. On the other hand, 252 (54%) cases seen by the MRs were classed as category 2 “fit with restrictions”, while the ADs had only placed 111 (24%) in this category. The overall agreement between the assessors (AD vs. MR) was poor (Kappa K = 0.18).

Discussion. For cardiovascular diseases and for mental ill-health, access to additional information by the MR was the commonest reason for changing the fitness category, but for all other conditions factors such as the experience and knowledge of the MRs or their different interpretation of the standards were the most frequent reasons for a change to fitness category or to restrictions.

Conclusions. This study found that there was poor agreement between the AD’s decision and the subsequent MR’s decision regarding the fitness of those seafarers who decided to appeal against the AD’s initial assessment. The reasons for this are considered.

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Keywords

seafarer; approved doctor; medical referee

About this article
Title

Do Approved Doctors and Medical Referees in the UK agree when assessing a seafarer’s fitness?

Journal

International Maritime Health

Issue

Vol 63, No 2 (2012)

Article type

Original article

Pages

71-77

Published online

2012-09-03

Bibliographic record

International Maritime Health 2012;63(2):71-77.

Keywords

seafarer
approved doctor
medical referee

Authors

Isam Rustom
Tim Carter

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