Environmental Health Practice: Environmental Medicine

Environmental medicine deals with environmental effects on health of 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 assessment of environmental medicine should include thorough medical history taking and physical examination, the formulation of a differential diagnosis, and (whenever indicated) human biomonitoring, on-site inspections, and ambient monitoring. In environmental medicine, evidence characterization of the relationship between exposure and health impairment can often not be based on textbook knowledge or statements of national or international committees since the alleged exposures vary over time due to changes in the production processes, the technologies, and the risk perception of the population. In some cases, this makes it necessary to rely on ‘primary’ literature, that is, scientific studies and newly developed diagnostic methods when evaluating a clinical environmental case. For an appropriate risk characterization, a physician not specialized in environmental medicine should therefore consider referring cases with presumed environmentally related health impairment, if new techniques or substances are involved, to specialized centers.