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[Diagnosis in environmental medicine: basic principles and problems]

D Eis1, H G Sonntag

  • 1Umweltmedizinische Ambulanz des Hygiene-Instituts, Universitätsklinikum Heidelberg.

Zeitschrift Fur Arztliche Fortbildung Und Qualitatssicherung
|February 1, 1997
PubMed
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Environmental medicine diagnoses often involve extensive patient history and monitoring to identify internal exposures. However, typical environmental diseases are rare, with most "environmental patients" experiencing psychosomatic or psychosocial issues.

Area of Science:

  • Environmental Medicine
  • Clinical Ecology
  • Psychosomatic Disorders

Context:

  • Environmental medicine diagnosis involves detailed patient history, local examination, and biological monitoring to identify internal exposures.
  • Conventional medicine diagnosis differs by not emphasizing these environmental factors.
  • Physicians in environmental medicine can offer advisory input to conventional medicine in specific cases.

Purpose:

  • To evaluate the diagnostic and therapeutic claims of environmental medicine.
  • To contrast the diagnostic approach of environmental medicine with conventional practices.
  • To assess the scientific validity of environmental medicine claims and practices.

Summary:

  • Environmental medicine diagnosis focuses on identifying internal exposures and their effects, differing from conventional diagnosis through expanded anamnesis and biological monitoring.

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  • Despite its expansion, environmental medicine can only establish a plausible causality between environmental agents and health disturbances in less than 10% of outpatients.
  • The majority of patients seeking environmental medicine consultation suffer from psychosomatic and psychosocial disturbances, often exacerbated by fear and misinformation, rather than direct environmental toxicity.

    • Impact:

    • The expansion of diagnostic services in environmental medicine creates a false impression of specialized competence, leading to unnecessary examinations and ineffective treatments for patients.
    • Many "environmental patients" are misdiagnosed, with their underlying psychosomatic or psychosocial conditions being overlooked.
    • Clinical ecology, a related field, often employs scientifically questionable methods, further complicating patient care and necessitating critical evaluation by independent research groups.