When treating a patient who is ill as a result of working in agriculture, there are some specific factors physicians should consider. A case study published in the AMA Journal of Ethics outlined these particular issues and how physicians should go about addressing them using the case of Mr L, an agricultural worker, and Dr A, a physician who works with patients from several agricultural counties.
Nicole Civita, JD, LLM, instructor in the sustainable food systems specialization in the Masters of the Environment Graduate Program at the University of Colorado Boulder, illustrated the case of Mr L, a local farm worker. Mr L visited Dr A complaining of stomach pain, nausea, and diarrhea. Dr A discovered that Mr L was working in fields adjacent to where pesticides and herbicides were being sprayed. Dr A concluded that Mr L’s symptoms were cause by this exposure and counseled him to stay out of the fields and away from his work until the spraying was completed. Mr L responded by saying that wouldn’t be possible because he could not afford to miss work. Dr A wondered how to proceed and whether his other patients who were also farmworkers in the area were being injured in the same way because of the exposure.
Ms Civita outlined the various unique circumstances and vulnerabilities of farmworkers, including factors that physicians should keep in mind when treating patients who are farmworkers with work-related injuries. One of these is the inherent hazards of farm work. Working in agriculture takes a toll on workers’ bodies, from the physical nature of the work to injuries caused by their environment, such as exposure to pesticides. These employees may also experience harsh living conditions, which can add to their relative unhealthiness.
In addition, many farmworkers face systematic disadvantages that promote frequent migration, which can have an effect on mental as well as physical health. Farmworkers are also deeply dependent on their jobs relative to many other industries. In the case of a worker like Mr L, whose family lives paycheck to paycheck, skipping shifts to recover from an illness is often not an option. Farm work tends to be low paying, and housing for agricultural workers may be employer provided, further discouraging employees from missing work.
Because farm workers generally have unique circumstances compared with other patients, physicians like Dr A who treat them need to be mindful of their patients’ lifestyles and specific considerations. Someone like Dr A should gather as much context as possible on his patients’ lifestyles to more accurately advise treatment. By further understanding the local working conditions, Dr A could make alternate advisements such as taking on “lighter” work or recommending a less hazardous placement for a patient like Mr L. Because many farm workers in the United States are migrants, they may not have access to measures such as safety equipment and washing facilities. A physician should discuss these matters with a patient where they are relevant to the patient’s health and provide any written information or instructions in the patient’s native language for ease of comprehension.
Farm workers are often unable to find time or transportation to visit a physician as Mr L did, so physicians who work in agricultural areas may find it useful to build a network of additional resources for patients. They may also find it helpful to make themselves accessible on site for farm workers. This could also allow for dialogue between the physician and the owner or supervisor at the work site. Additionally, understanding the system of compensation can allow physicians to make informed diagnoses and treatment recommendations to best aid their patients.
To further assist their patients, physicians treating farm workers should report any unsafe conditions, including exposure to toxins, to the proper authorities. Many states mandate pesticide incident reporting, so someone like Dr A whose patient has been affected by pesticides should learn about and follow any necessary reporting requirements.
Farm workers are prone to injury, but because of the nature of their jobs are often unable to seek proper treatment and heal fully. Physicians who treat them should take all of these lifestyle factors into account, as well as opening a dialogue to better understand their patients’ needs. Along with working closely with their patients to form effective treatment recommendations, physicians should understand their legal duties in the context of reporting any unsafe working conditions their patients face. By following these guidelines, physicians can help provide proper care to a population that sometimes struggles to obtain it.
Civita N. How should physicians help patients who are ill because they work in agriculture? AMA J Ethics. 2018;20(10):E932-E940.