Environmental medicine counselling in daily medical practice

Since 2008, the Swiss Society of Doctors for the Environment runs a small interdisciplinary environmental medicine counselling structure for patients with complaints attributed to environmental exposures. The model is embedded in everyday practice with a central coordination and consultation office as well as a network of general practitioners interested in environmental medicine who make environmental medical assessments and consultations based on a standardised protocol in their practices. If necessary, environmental experts are consulted and home investigations are conducted. An evaluation study concluded that this model is feasible and addresses an existing need. The assessment option is experienced as helpful by patients. The interdisciplinary collaboration with environmental experts has proved to be effective. The aim of the assessment is to detect or to rule out common diseases and to analyse the impact of suspected environmental burden on the complaints in order to find individual therapeutic approaches. The progression of common medical and psychiatric illnesses can be negatively affected by environmental influences, too. The main instrument of the assessment is an extensive medical and psycho-social history with an additional environmental history including a systematic questionnaire and environmental key questions. Close collaboration with the family doctor is crucial. Assessment steps can be streamlined and consultation suggestions can be embedded in the family doctors holistic and lasting concept of treatment. Where possible our society gladly provides family doctors with our practical environment-related expertise. It is an important concern for us to make environmental medicine an integral part of primary care, also in the process of informing the patient about the prevention of and precautions against harmful or potentially harmful environmental burdens. We hope that the experiences made in our project will contribute to this goal.