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

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.

Chemical intolerance: involvement of brain function and networks after exposure to extrinsic stimuli perceived as hazardous

“…In light of this model, distracting attention from odorous or pungent substances may be effective for the recovery from CI status, resulting in the treatment of CI. In the clinical practice, adequate assessment of exposure history for identifying the agent substance which should be avoided would have an important role for the recovery of a patient with CI [100]. Interestingly, a 5-year follow-up study reported that appropriate physical activity and maintaining a regular lifestyle, including diet or sleep, were significant factors for the improvement of CI [101].…”

Saliva as a diagnostic tool to measure polycyclic aromatic hydrocarbon exposure in dental patients exposed to intimate partner violence (IPV)

“…While the saliva exposome studies published elsewhere [ 85 ] were able to capture the endogenous and therapeutic agent-derived compounds/metabolites, pollutants were not represented in detail in that report due to lack of sufficient data. Both the clinician and basic scientist continue to face challenges in assessing toxicant loads in the absence of comprehensive educational resources, definitive laboratory tests, established dose–response relationships or exposure history tools [ 86 ]. A timeline of exposure history will continue to be the most useful clinical tool for assessing toxicant exposures, until standardized assessment tools can be calibrated to be applied universally.…”

The Growing Relation between Environment and Public Health

“…However, adapting their knowledge to the needs of patients is not always clear due to the lack of literature on EM clinical practice and little qualitative research on the perspectives of environmental professionals. EM practitioners can be divided into two main groups: integrative physicians (IP) who use knowledge from other medical disciplines to treat patients with chronic, complicated, misdiagnosed conditions involving multiple systems and environment physicians (OEP) who treat employees based on their occupational exposure to toxic substances [29]. However, while in developed countries, these two types of practices exist separately, in Albania neither of them exists.…”