Expert clinician's perspectives on environmental medicine and toxicant assessment in clinical practice

Bijlsma, N and Cohen, M 2018, 'Expert clinician's perspectives on environmental medicine and toxicant assessment in clinical practice', Environmental Health and Preventive Medicine, vol. 23, no. 1, pp. 1-14.


Document type: Journal Article
Collection: Journal Articles

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Title Expert clinician's perspectives on environmental medicine and toxicant assessment in clinical practice
Author(s) Bijlsma, N
Cohen, M
Year 2018
Journal name Environmental Health and Preventive Medicine
Volume number 23
Issue number 1
Start page 1
End page 14
Total pages 14
Publisher Springer
Abstract Background: Most clinicians feel ill-equipped to assess or educate patients about toxicant exposures, and it is unclear how expert environmental medicine clinicians assess these exposures or treat exposure-related conditions. We aimed to explore expert clinicians' perspectives on their practice of environmental medicine to determine the populations and toxicants that receive the most attention, identify how they deal with toxicant exposures and identify the challenges they face and where they obtain their knowledge. Methods: A qualitative study involving semi-structured interviews with expert environmental clinicians in Australia and New Zealand was conducted. Interviews were recorded and transcribed, and themes were identified and collated until no new themes emerged. Results: Five dominant themes emerged from 16 interviews: (1) environmental medicine is a divided profession based on type of practice, patient cohort seen and attitudes towards nutrition and exposure sources; (2) clinical assessment of toxicant exposures is challenging; (3) the environmental exposure history is the most important clinical tool; (4) patients with environmental sensitivities are increasing, have unique phenotypes, are complex to treat and rarely regain full health; and (5) educational and clinical resources on environmental medicine are lacking. Conclusions: Environmental medicine is divided between integrative clinicians and occupational and environmental physicians based on their practice dynamics. All clinicians face challenges in assessing toxicant loads, and an exposure history is seen as the most useful tool. Standardised exposure assessment tools have the potential to significantly advance the clinical practice of environmental medicine and expand its reach across other clinical disciplines.
Subject Environmental and Occupational Health and Safety
Keyword(s) Clinical practice
Environmental health
Environmental medicine
Environmental sensitivities
Exposure assessment
Exposure history
Multiple chemical sensitivity
Occupational and environmental medicine
Toxicant assessment
Toxicant biomarkers
DOI - identifier 10.1186/s12199-018-0709-0
Copyright notice © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
ISSN 1342-078X
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