Clinician Engagement: The Role of the Physician @Medici_Manager

By Amy Collins, M.D.
HealthCare Sustainability Consultant, Vanguard Health Systems

I was living a pretty green life, or so I thought. I had been composting for years, was an avid recycler, was known for turning off lights and computers not in use and grew up using reusable grocery bags – doing it all because it just made sense. But my attitude towards greenness and reason to be environmentally responsible changed in one minute back in April of 2007. On one of my days off from my full time job as an emergency physician, I was sitting in my car in the pick up line at my son’s school, absent-mindedly texting and listening to the radio while IDLING! My very wise 4th grader took no time to begin reprimanding me for my lapse in environmental responsibility. “You are idling,” he scolded.  “Ms. Gruenfeld (his teacher) taught us about climate change today and what is happening to the polar bears.” He went on. “I better not catch you idling EVER again and there’s a lot more you should be doing about climate change and to help the polar bears.”  Shame faced, I agreed and assured him that I would get right to work to try and correct my wrong. As a family, we watched “An Inconvenient Truth,” then set out to make our home as green as possible. Inspired by the urgency in the movie and by a wise little boy, we started doing such things as changing all of our light bulbs to fluorescents, drying clothes on a clothes line, planting a vegetable garden, making homemade cleaning products and much more.

Soon it became uncomfortable living one way at home and another at the hospital. It grew harder and harder to leave my environmental conscience at the door when I went to work. In response to this discomfort, I set out to start a recycling program in my ER but was told by a fellow employee that recycling was “illegal” in a hospital. Not satisfied with this response, I turned to the Internet and learned that not only was recycling not illegal in a hospital and that there were many exciting and practical opportunities for a hospital to reduce it’s environmental impact. It was at this moment that I knew that I had found my calling. I wrote a letter to my administrators and requested that we take steps to become a more sustainable operation, was given permission to run, started a green team and so began my mid-life second career path.

I realize that not all physicians will share my passion for health care sustainability or have the time to commit to a leadership role at their hospital, but there are many important opportunities for physician engagement at local and broader levels. When speaking to physicians I focus on sustainability as a preventative health strategy and an opportunity for improved health and health care delivery.  Let’s look at some of the issues. According to The Lancet, “Climate change is the biggest global health threat of the 21st century – the impacts will be felt all round the world – and not just in some distant future but in our lifetimes and those of our children.” Physicians need to advocate for health to be at the center of the climate debate as the health impacts are anticipated to be significant, including increases in respiratory illnesses, allergies, food and water borne illnesses, infectious diseases along with health impacts of weather disasters and heat waves.  In addition, there is scientific evidence linking the combustion of fossil fuels to lung cancer, respiratory illness, heart disease and other chronic illnesses.  I think that Margaret Chen, Director General of the World Health Organization, says it best, “The health sector must add it’s voice loud and clear – and fight to place health issues at the center of the climate agenda.”

Let’s briefly look at some of the other things I have learned over the past few years that concern me as a parent and a physician. The US spends billions annually to treat chronic diseases such as obesity and diabetes, both of which are increasing in incidence at an alarming rate and burdening our health care system. Scientists now suspect that endocrine disrupting chemicals may play a role in the development of both diabetes and obesity. These chemicals even have a name – “obesogens” – chemicals that may promote weight gain and obesity. Bet you never learned about this in medical school! The incidence of other chronic diseases with potential environmental links, such as asthma, autism and certain cancers are increasing at alarming rates. A 2008 Associated Press study found traces of pharmaceuticals in the drinking water of millions of Americans.  A 2005 study by the Environmental Working Group found over 200 industrial chemicals in the cord blood of ten newborn infants. DEHP, a plasticizer, which is an androgen antagonist, is found in many medical devices including IV bags and tubing. A 2007 Lancet study showed that nurses have the highest incidence of occupational asthma of any profession.  We have mercury, a potent neurotoxin, in our clinical and facility devices, pharmaceuticals and lab reagents. Around 80% of the antibiotics used in this country are used non-therapeutically in livestock, which experts agree is linked to antibiotic resistance in humans. I could go on and on, but it is beyond the scope of this blog.

So, what’s a busy physician to do with all this disturbing information?

At The Bedside

  • Incorporate environmental history taking into practice
  • Evaluate diagnostic imaging ordering practices and reduce patient’s exposure to unnecessary radiation
  • Educate patients about environmental exposures, healthy food and beverage options, proper medication disposal and the public health impacts of climate change
  • Practice “Green Pharmacy” – evaluate personal prescription practices (i.e. limit refills and quantities), consider non-pharmaceutical treatments when appropriate, regularly review medications with patients

In the Hospital

  • Advocate for procurement of healthy, local and sustainable food and beverages and for the elimination of sugar sweetened beverages
  • Advocate for toxicity reduction
    • ​Use of Green Seal Certified cleaning products
    • Mercury elimination
    • DEHP reduction
    • Fragrance-free and no-smoking policies
  • Advocate for pharmaceutical waste management program and education about proper medication disposal
  • Advocate for Grand Rounds and educational programs about environmental topics (or give a talk yourself!)
  • Advocate for a climate policy and preparedness
  • Encourage reprocessing of single use surgical devices and other sustainable initiatives in the OR
  • Join or start a green team
  • Encourage your hospital to join PGH and enroll in HHI
  • Agree to be your hospital’s “Clinical Champion”
  • Lead by example – support your hospital’s recycling program, use red bags properly, turn off lights not in use, reduce your paper usage!

Get Educated!!

Most physicians haven’t had any formal training or education about health care sustainability but there are some great opportunities for education

Advancing sustainability in the health care sector

  • Engage in research activities – the industry is in need of science based evaluation of sustainable best practices
  • Publications – write an article for your hospital newsletter, local newspaper or write a peer –reviewed article
  • Speaking engagements – speak to a variety of health care audiences

National Advocacy: advocate for climate change policy, chemical reform, antibiotic legislation and more. Let your voice be heard!

More and more physicians are recognizing the link between environmental choices and health and the environmental impact of hospital operations. Physicians have many opportunities to advance sustainability within their organizations and the health care sector and to bring this important work to our patients. Sustainability broadens my understanding of the Hippocratic Oath, as in my practice I now consider “First, Do No Harm” to mean doing no harm to patients, workers, the community and the environment.

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