ABSTRACT
Occupational medicine is an important medical discipline in Belgium, with about one thousand of experts. Roles of the occupational physicians must be analyzed on the basis both of legal prescriptions and real practice. The examination of the roles of the occupational physician in various countries shows that regulation are an important legal framework from which he can deploy his practice. A contrario it is also the means which makes it possible to the unions and the management to force him. However the real roles are definitely broader than the regulations let understand, concerning very diverse fields which make this medical discipline a real preventive general medicine. It is less and less a public health discipline and approaches gradually in practice the clinical disciplines, in the sense that the singular colloquium, the knowledge of the particular work places and risks of every worker and the individualization of the action are its bases. On the other hand, fitness for work assessments and its procession of authoritarian medical and administrative acts, heritages of the public health, hardly efficient, should largely disappear from the prescriptions. It will allow for a wider deployment of the activity of the occupational physician towards the industrial organisations, by proposing the necessary adaptations of the work places, the limitations of exposure to harmful effects, the remediation of the psychosocial load, etc, through "preventive prescriptions". Complementarily, the population ageing imposes new solutions to rehabilitate the old workers, and this will be likely to modify, not only the medical approach in work environment, but also already imposes a closer cooperation with the general practitioner, which is likely to improve the action abilities of both medical disciplines.