Grand Rounds in Environmental Medicine

With this issue, Environmental Health Perspectives initiates a new series: Grand Rounds in Environmental Medicine. In this new series, we will present cases drawn from real life that represent problems commonly encountered in environmental medicine. Some of the cases will be routine; others will have a twist, a twist that is not too unordinary, but rather is illustrative of some of the variations that might occur with a particular environmental illness. All cases will be discussed by a recognized expert in the field who will provide a concise but state-of-the-art appraisal of the scientific and medical issues surrounding the evaluation and management of the case. The design of Grand Rounds in Environmental Medicine begins with a patient; traces the steps of an expert who will attempt to harness all of the best research in this area, coupled with his or her own experience and intuition, to formulate an approach to the diagnosis and management of the problem; and ends with the patient. Our goal is to provide real-life examples that will resonate with the experiences of many of our readers and demonstrate approaches that could be taken in any physician's practice. The pages of this journal are already crowded with reports of important scientific investigations that cover the gamut of environmental health research, but many physicians are looking for basic knowledge and techniques for evaluating and managing patients with suspected environmental disorders. Numerous studies have documented the continuing absence of curriculum development in the area of environmental medicine in our medical schools (1). Physicians who specialize in this area remain few in number (less than 1,000 in the United States). Primary care physicians have all along been the care providers who are most likely to see environmental disorders (4), and current trends in health care delivery are, in general, making it difficult for patients to be referred to specialists. Moreover, even among physicians who have the motivation to educate themselves in environmental medicine, it must be remembered that the practice of medicine combines both science and art. Physicians are indoctrinated in this axiom time and time again during medical school and years of residency training. The art of medicine refers to the ability to extract from a mass of often contradictory symptoms, physical signs, and laboratory data those items that are of crucial significance in determining diagnoses and constructing a plan for managing a particular patient. It is a combination …