Abstract
BackgroundMost 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.MethodsA 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.ResultsFive 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.ConclusionsEnvironmental 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.
Highlights
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
environmental medicine (EM) requires the integration of knowledge from diverse fields and the skills to apply this knowledge in a wide variety of circumstances, yet this skill set is poorly defined and Bijlsma and Cohen Environmental Health and Preventive Medicine (2018) 23:19 it is unclear how experts apply their knowledge to the needs of their patients
We undertook a qualitative study of environmental physicians with the aim to determine the nature of EM practice and identify how expert EM clinicians deal with environmental toxicant exposures
Summary
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. Whilst most clinicians acknowledge that environmental toxicants affect human health and are frequently asked about exposures by their patients, a lack of environmental health training and standardised exposure assessment tools leaves most clinicians feeling ill-equipped to assess or Expert environmental medicine (EM) physicians require skills in clinical medicine, they require specialised knowledge about the impact of different toxicants on human health, exposure sources and dose estimation, the factors that influence inter-individual variation to toxicant exposures, interpretation of laboratory tests, measures to minimise toxicant exposures and interventions that treat different sequelae. We further aimed to determine where clinicians obtained their knowledge and skills, the populations and toxicants that receive the most attention and the challenges they face in order to inform the development of resources and tools that can be used by all clinicians
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