Clinical environmental medicine

Abstract

Introduction: Clinical environmental medicine deals with environmental effects on human health in individual patients. Patients seek medical advice for problems of many different kinds that may be due to environmental exposures; such exposures must be considered carefully along with other potential causes. An environmental medical assessment should include thorough medical history-taking and physical examination, the formulation of a differential diagnosis, and (whenever indicated) human biomonitoring, site inspections, and ambient monitoring.

Methods: This review of clinically relevant environment-related health disturbances is based on a selective evaluation of the pertinent literature and of own experiences.

Results: Overall, relevant environmental exposures can be identified in up to 15% of patients who attribute their health complaints to environmental factors. (Clinical disorders are more common and more severe in these patients.) 40% to 75% are found to suffer from other physical and/or emotional conditions without any specific environmental aspect, i.e., without any apparent or verifiable exposure.

Discussion: Despite the relative rarity of verifiable environmentally related health disturbances, these must be clearly identified and delimited to avoid further harmful exposures. Environmental medical counseling should include risk assessment and behavior recommendations for all patients who attribute their medical problems to their environment. Physicians performing specific environmental-medical diagnostic procedures must be aware of their limitations in order to avoid performing tests whose results have no therapeutic consequences and are thus of no help to either the physician or the patient.

Keywords: consultation; environmental medicine; environmental pollution; monitoring; multiple chemical sensitivity.

Figure

Diagnostic procedure and treatment options in environmental medicine (after Wiesmüller 2002 [18] and Herr et al. [e18]). Principal diagnoses explain all of the patient’s symptoms, while secondary diagnoses explain only some of the symptoms. DD, differential diagnosis