Research: BIJLSMA and COHEN,

Listed in Issue 293


BIJLSMA and COHEN, 1 RMIT, School of Health and Biomedical Sciences, PO Box 71, Bundoora, Victoria, 3083, Australia. ; 2 RMIT, School of Health and Biomedical Sciences, PO Box 71, Bundoora, Victoria, 3083, Australia.


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.


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.


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.


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. Conflict of interest statement  Author’s information NB has 15 years’ experience in naturopathy and acupuncture, has a graduate diploma in occupational health and safety and is the principal of the Australian College of Environmental Studies and a PhD candidate. MC is a registered general medical practitioner with more than 25 years’ experience and a professor at RMIT University. Ethics approval and consent to participate The study was approved by the RMIT University Human Research Ethics Committee BSEHAPP 25-15. Clinicians gave their informed consent in writing or audio. Competing interests The authors declare that they have no competing interests. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Nicole Bijlsma  1 , Marc Maurice Cohen  2.  Expert clinician's perspectives on environmental medicine and toxicant assessment in clinical practice. Environ Health Prev Med. 23(1):19. doi: 10.1186/s12199-018-0709-0. May 16; 2018.

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