Situationsbericht klinische Umweltmedizin Beispiel Nordrhein-Westfalen
In the 1980s, in Germany, starting with North Rhine-Westphalia (NRW), environmental medicine was instituted as a specific medical field at the universities and in the public health and primary health c are sec tor. Germany was the world-wide leader in the establishment of environmental medicine. Previously published experiences in environmental medical care show that a causal relationship between health disorders and the assessed exposure could be excluded on average in only up to 8 % of the patients with environment-related health disorders who consulted an environmental medical advisory centre or an outpatients’ unit for environmental medicine. In the case of resident doctors the percentage is 41 %. For the environment-associated syndromes multiple c hemical sensitivity (MCS), idiopathic environmental intolerances (IEI), sick building syndrome (SBS), chronic fatigue syndrome (CFS), Candida syndrome (CS), burnout syndrome (BS) and environmental somatisation syndrome (ESS) fundamental knowledge about aetiology, pathology, pathophysiology, diagnostics, therapy, prognosis and prevention is still lacking. In NRW, although environmental medical advisory centres, resident doctors with additional training in environmental medicine and model projects for financing environmental medic ine exist in the area of both state medical boards, the needs of environmental medical care are not met. This is also true nation-wide. Additionally, payment projects comparable to those in NRW are not available nation-wide. The reasons the demands of environmental medical care are not fulfilled are independent of financing problems and lie in the uncertain area of additional training (planned cancellation of the additional training in environmental medicine) and deficits in valid exposure assessment, valid objectifying and quantifying of environment-related complaints, valid judgement of cause-effect relationships, adequate treatment possibilities, prevention concepts, and risk communication. In addition, false diagnoses, wrong attribution and the misleading of patients must be taken into account. Not only in NRW but also nation-wide, the answer to this problem is only possible with professional and appropriate clarification of the aforementioned deficits and the linking of quality environmental medical care with result-oriented payment.
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