[Diagnosis in environmental medicine: basic principles and problems]

Diagnosis in environmental medicine only differs from the conventional medical diagnosis in a more detailed expositional evaluation on the basis of a respectively expanded anamnesis and a possible local visit, a surrounding examination as well as a so-called biological monitoring. Thus, the essential element of the "diagnosis" in environmental medicine consists in the resolving of a possible internal exposure (and occasionally resulting effects). From this point of view, physicians in environmental medicine could give an advisory contribution to the conventional medicine in selected cases. In contrast to frequently occurring assertions, there are practically no typical environmental diseases due to usual environmental toxicants. At present, a causality between environmental agents and health related disturbances can only be made plausible in less than 10% of out-patients of environmental medicine. These figures are in total contrast to the expansion of the out-patient and clinical environmental medicine. The expansion of the diagnostic offer gives not only to the public but also to the patients and the physicians the impression of a specific competence in diagnostic and therapy of environmental medicine which to this extent does not exist. The consequences are unnecessary and unsuccessful examinations. This is of no help to the patient. Most of the "environmental patients" suffer from civilization caused/psychosomatic and psychosocial disturbances like e.g. phobias, and somatoforme or depressive disturbances. In the genesis probable an increasing readiness for fear, unrealistic threatening convictions (arranged by media, homeopathists, physicians and other authorities), growing fear disturbances as a consequence to this as well as the cognitive connection of "normal" inner disturbances with the suspicious agens play a decisive role. For these patients the clinical environmental medicine lead astray. This is significantly more valid for the numerous "clinical ecologists" who apply scientifically doubtful methods. Considering the clinical approach to environmental medicine urgently needs a critical evaluation by independent research groups.