Agency for Toxic Substances and Disease Registry 
Case Studies in Environmental Medicine (CSEM) 

Taking an Exposure History
Summary and Follow-Up

Summary

In each scenario, the clinician’s pursuance of the exposure history led to discovery of toxic exposure for each of the three patients.

In each case, the diagnosis and treatment might have been inappropriate without an exposure history. The process required only a few minutes of the clinician’s time; each history was focused as indicated by the patient’s reported symptoms.

Using the exposure history in managing the patients’ problems, as well as guiding the patients in appropriate preventive behaviors, is the practice of preventive medicine at its best.

Follow-Up

Consultation

Industrial hygienists, who are often employed by state health departments or industry, are a source of information to the clinician investigating a possible toxic exposure. Industrial hygiene is the discipline devoted to the recognition, evaluation, and control of workplace-related factors or stresses that may cause illness, impaired health or well-being, or significant discomfort and inefficiency among workers or community members.

Other medical specialists, such as clinicians specializing in occupational/environmental and general preventive medicine, can be helpful in assessing whether a significant exposure has occurred. Occupational health nurses, who often work at patients’ work sites, also have expertise and experience that may be valuable to the clinician.

Referral Resources

The clinician is encouraged to build a network of occupational and environmental medical specialists for information, consultation, and referral.

The Association of Occupational and Environmental Clinics (AOEC) is a network of clinics that provide professional training, community education, exposure and risk assessment, clinical evaluations, and consultative services.

Pediatric Environmental Health Specialty Units (PEHSUs) have been developed to provide education and consultation for health professionals, public health professionals and others about the topic of children's environmental health. AOEC coordinates the activities for all of the PEHSUs.

Education and Resource Centers (ERCs) have been established in academic centers by the National Institute for Occupational Safety and Health (NIOSH) to educate professionals in occupational medicine topics. ERCs offer training courses in occupational and environmental medicine topics; continuing medical education credit is available.

Key Points

• It is important for clinicians to start taking an exposure history if they haven’t done so.
• Many consultation and referral sources are available to help general practice physicians to play their roles in detecting, treating, and preventing diseases from environmental exposure.