Endocrine-Disrupting Chemicals: from Basic Research to Clinical Practice. Gore AC, ed., Totowa, NJ: Humana Press, 2007 Jun; :289--307
Health care providers often discuss issues of risk and uncertainty with patients in the context of surgery, diagnostic tests, immunizations, or treatment. Communication of potential risks and benefits before making a voluntary decision is the foundation of informed consent. Communication about environmental health risk differs from medical informed consent in that the hazard usually involves involuntary exposure, may be unfamiliar, provides no benefit to those exposed, and there often is much less known about the potential risks. Health care providers may not know where to find information to answer questions related to environmental health generally, or endocrine disruption specifically. Even when scientific information is available about the health effects of chemical exposure, it is almost never enough to answer questions pertaining to individual risk (as opposed to population risk) and rarely addresses issues related to the long-term effects of poorly quantified exposure during vulnerable periods of development of the fetus, young child, or adolescent. Despite the paucity of relevant information, health care providers have an important role to play in communication of risks associated with endocrine disruptors and other environmental toxicants. There is widespread concern among the general public about environmental health risks, especially risks to infants and children. Patients frequently come to their health care provider's office with questions about environmental hazards. A survey of pediatric patients found that exposure to "environmental poison" leads the list of issues that parents worry about but that pediatricians rarely gave advice on this topic. There are three major settings in which health care providers may need to communicate with people about environmental health risks. The most obvious setting is the clinic or office, where discussions occur about personal risk to specific individuals. Second, health care providers are sometimes called upon to provide information in workplaces, schools, or community settings, where there is a potential environmental risk to a group of people, or a perceived cluster of disease. Third, health care providers may occasionally be caned upon to address the public at large and to comment on the public health significance of scientific findings. The latter situations may involve conversations with the media or policymakers.
Age-groups; Airborne-particles; Air-contamination; Biological-effects; Biological-function; Cell-biology; Cellular-reactions; Chemical-hypersensitivity; Chemical-properties; Chemical-reactions; Children; Environmental-exposure; Environmental-factors; Environmental-hazards; Environmental-health; Environmental-medicine; Exposure-assessment; Exposure-levels; Exposure-methods; Fertility; Fetus; Health-care; Health-care-facilities; Health-care-personnel; Health-hazards; Hormone-activity; Hormones; Humans; Medical-facilities; Medical-monitoring; Medical-personnel; Medical-services; Medical-treatment; Neurotoxic-effects; Organic-chemicals; Pathogenesis; Physiological-effects; Physiological-factors; Physiological-function; Physiological-response; Poisons; Pollutants; Pregnancy; Prenatal-exposure; Public-health; Quantitative-analysis; Racial-factors; Reproductive-effects; Reproductive-hazards; Reproductive-system; Reproductive-system-disorders; Risk-analysis; Risk-factors; Statistical-analysis; Surgery; Tissue-disorders; Training; Women; Work-environment