[Social medicine evaluation of pre-employment medical screening of civil service candidates].

The findings and resulting number of rejections from 9.043 medical examinations of candidates for posts as civil servants in 1994 in Bavaria and a retrospective evaluation of 500 examinations at two large public health departments in Bavaria were used to discuss the value of such examinations and present possible alternatives. The rate of rejections for medical reasons in the 9.043 examinations of civil servants starting new jobs in Bavaria was 0.57%. The most frequent reason for rejection was obesity. In the retrospective evaluation of 500 medical examinations of candidates starting new jobs there were no cases of final rejection for medical reasons. In 0.4% of cases (n = 2) the candidates were considered suitable for the probationary period before becoming a civil servant, but unsuitable for health reasons for a life-time post in the civil service. In 27% of cases the findings were normal without any diagnosis stated in the examination report. The most frequent diagnoses were refractive ametropia (55.8%) and changes in the locomotor system (22.2%), in particular deviation of the axis are vertebral column (17.6%). The results are comparable with those obtained in studies carried out in Europe, although the procedures and study designs differed. Even with a low number of rejections of around 0.5%, examinations of the candidates economically justified for the employer (the state). In view of the high number of civil servants taking early retirement, the sensitivity and specificity of the medical examinations before starting work are discussed, as well as possible and better alternatives to a single examination. One suggestion is continuous monitoring of all civil servants by a physician specialised in occupational medicine, although in particular for teachers and office workers no standards have been developed for the scope and frequency of occupational-medical health checks and consultation.