Center for Environmental Oncology

Clinical Education at CEO-UPCI

by: Jonathan Weinkle, MD, Resident, General Medicine, UPMC

What To Tell Your Doctor About Your Environment

Use the Community, Home, Hobbies, Occupation, Personal Habits, and Diet (CH²OPD) system This list does not cover all possibilities, but it should get you started when talking with your doctor about your health and the environment.

Community: What businesses, waste sites, safety hazards, major roads, power lines, plants, or nuclear recycling facilities, safety hazards, or major roads are located in your neighborhood, town, city, or state?

Home: Does your home contain lead paint, paint products, pesticides? What kind of heat (oil, gas, water, electric, wood, propane, kerosene), humidity control, and ventilation do you use? Are there carpets or hard floors? Have there been recent renovations? Is there radon gas in the basement?

Hobbies: Do your hobbies include gardening, hunting, crafts, sports, or other pastimes that could involve exposures to toxic chemicals, lead or other metals, or safety hazards?

Occupation: What is your job, your exposures on the job, and what kinds of safety precautions (lead aprons, masks, radiation badges, hard hats) do you take to protect yourself? Do you ever wear your work clothes home, potentially exposing your children to dusts, odors, chemicals, or even infectious agents from work?

Personal habits: What kinds of cosmetics and other personal care products, cleaning products, and medicines are used in the house? How are they kept away from small children? Does anyone in the home smoke, and if so, where, and who is possibly exposed?

Diet: Do you eat organic or non-organic produce, raw or undercooked fish and meat, or fish and game that you caught yourself? If so, where was it caught? What kinds of pots, pans, and containers do you use? Do you microwave in plastic containers? What kind of water (well, municipal, bottled, filtered) do you drink?

Sidebar adapted from Marshall, Weir, Abelsohn & Sanborn (2002) Identifying and managing adverse environmental health effects: 1. Taking an exposure history. CMAJ 166, 1049-1055.

Think back a few years to the dockworker strikes in California. Valuable goods sat undelivered on ships in Los Angeles and Long Beach, imported fruit spoiled awaiting shipment across the country, and people all over the United States found themselves without food and other items they had been counting on.

Now fast forward to today. Looking through this newsletter, you will find exciting and eye-opening news about breakthroughs in environmental health. But will that same information be provided to you the next time you see your physician? Will your internist ask you about the risks posed to your health by the businesses in your neighborhood? Will your child's pediatrician pass on advice about how to protect your child from household environmental hazards? Will your family physician be involved in policy efforts to improve the safety of your air and water? Unless we deliver our new findings to the people who can use the goods, they will remain stranded at the dock, and the people who need them, namely you, won't reap the benefits.

Efforts are now underway at the Center for Environmental Oncology of the University of Pittsburgh Cancer Institute (CEO-UPCI) to ensure that information makes it to everyone who has a need to know. Doctors communicating with their patients about the health risks in their environment will begin to happen regularly whenever patients, both well and ill, visit their physicians. During the 2005-2006 year, the first steps in this direction were taken at Children's Hospital of Pittsburgh (CHP) when Dr. Orode Doherty, then a resident in her final year of training, created a five-part environmental health curriculum as part of the regular noon lecture series for pediatric residents. Now, our goal is to work with the chief residents to expand the number of topics in the series and make it a permanent part of the training program, so that no pediatric resident will leave CHP without an understanding of how the environment influences child health and how to address these issues with patients.

In addition, CHP was recently chosen as the site for the 4th annual Conference on Children's Health and the Environment, sponsored by the Mid-Atlantic Center for Children's Health and the Environment, based at Children's National Medical Center and George Washington University in Washington, D.C. The conference for health professionals will be held on Saturday, Oct. 21 [2006], and will provide pediatricians and family practitioners with training on environmental health topics including:

understanding how the built environment affects obesity, infant development, and classroom learning
identifying and reducing exposures to neurotoxins including lead and mercury
identifying environmental triggers and remedies for asthma
understanding the role of prenatal exposures to toxins such as pesticides on the development of childhood health problems

From these beginnings, we hope to move on to other means of reaching physicians by creating curricula similar to the CHP model for other residencies in the UPMC system. We will:

create online resources that practicing physicians can use to expand their environmental medicine skills while earning continuing medical education credits.
work to integrate environmental health topics into clinical Grand Rounds, generally the highest profile in-house conference that physicians in a given specialty attend.
work to improve physicians' knowledge of occupational medicine, in order to better enable them to diagnose and treat work-related illnesses.
and finally, create a standardized model for physicians to use in screening their patients so that they will be able to identify important environmental exposures before their patients get sick, and will be able to work more effectively to prevent illnesses such as cancer, asthma, and heart disease.

In the meantime, make sure you share information about your "environment" with your doctor, so that she or he can use that information to help you get healthy and stay healthy. Using the CH²OPD (Community, Home, Hobbies, Occupation, Personal Habits, and Diet) system described [in the sidebar], you can put together most of the basic information you need to tell your doctor about the environment you now live in or have lived in in the past. If we can help to bring together patients who are more aware of their environments with doctors who are more knowledgeable about environmental risks, we can really begin to clear the smoke.

Published September 14, 2006.