Evidence-based medicine and evidence-based occupational health

Although we agree that scientific evidence is an absolutely necessary basis for modern medical practice, evidence may have other origins as well, such as narrative evidence (2) and intuition (3). This kind of evidence is useful for any practice of medicine, including occupational medicine. Indeed, the patient's story is more than a list of present or absent symptoms, which act as the stepping-stone to the scientific databases. Some symptoms are related; others are not. They can vary in "time" and "place" and constitute metaphors for another meaning. The way the story is told, including the expression of nonverbal signs and the like, is also noteworthy. Together with the patient, the doctor must delve into history coherence and meaning, which should be adequate in relation to the iatrogenic question raised. In occupational medicine, the challenge is not only to put forward a clinical diagnosis and an appropriate therapy. The work-relatedness of the disease and the prognosis in terms of work ability is always on the agenda, and relevant clues in this respect are often presented through the patient's history.