health worker specializing in one of the following areas: family medicine, internal
medicine, pediatrics, obstetrics/gynecology, emergency medicine, or public health.
Americans look to their primary care providers for guidance on health concerns.
Public concern about pesticides can come from a variety of sources. Patients may
have heard about pesticide issues in the national or local news, or read about the
health effects of acute or chronic exposure to pesticides. Concerned patients may turn
to their primary care provider for answers about their own risks of illnesses from ex-
posure to pesticides. They may question providers about acute health effects as well
as potential chronic effects, such as cancer, birth defects, reproductive effects, or other
conditions resulting from pesticide exposure. Primary care providers need to be pre-
pared to recognize, manage, and prevent pesticide-related health conditions in their
patients and communities. By helping patients recognize symptoms of pesticide-
related illnesses, and by problem-solving and evaluating risks from pesticides, primary
care providers can help patients reduce exposure and prevent future exposures.
While some progress has been made in introducing environmental health issues
into the curriculum of medical and nursing schools, most health professionals still do
not have adequate knowledge and tools to address patient and community concerns.
A survey of environmental medicine content in U.S. medical schools found that
75 percent of medical schools require only about seven hours of study in environmental
medicine over four years of education. Consequently, once in practice, physicians’
awareness and understanding of pesticide-related illnesses may or may not ever
increase.^25
The current lack of adequate environmental education for health care providers
sounds an alarm for leaders in the health care community, whose professionals are
not prepared to deal with pesticide-related illnesses as they are presented. Primary
care providers are on the frontline of health care and therefore can play a key role in
identifying, treating, and preventing potential pesticide exposure and poisonings.Importance of Exposure HistoriesThe clinical history is an essential part of data collection and doctor-patient com-
munication. The environmental history, including questions eliciting concerns and
probing environmental hazards to which a patient is exposed, should be included in
the routine medical history. However, physicians who do ask about environmental
exposures usually limit their inquiries to lead and environmental tobacco smoke.^26
In some situations where exposures are complex or multiple and/or symptoms
atypical, it is important to consider consultation with clinical toxicologists or special-
ists in environmental and occupational medicine. Local poison control centers should
also be consulted when there are questions about diagnosis and treatment.^27
Although the clinician’s concerns deal primarily with pesticide-related diseases and
injury, the approach to identifying exposures is similar regardless of the specific haz-
ard involved. It is important to ascertain whether other non-pesticide exposures are
involved because of potential interactions between these hazards and the pesticide of38 | Pesticides