Opinion | Healthcare professionals don’t have to choose between patients and the planet

If the US healthcare system were a country, it would have the 13th largest greenhouse gas emission in the world. You read that right: Our nation’s healthcare system alone contributes more to the climate crisis than the totality of most other countries.

After a recent column about how much health care is making climate change worse, I’ve been struck by the reactions that this shouldn’t be a priority for doctors and patients. As Jane from Virginia wrote: Isn’t health care facing bigger problems right now? Shouldn’t we be more concerned about how inaccessible drugs are and nurses leaving in droves?

This is understandable, as there is no shortage of problems in our healthcare system. But reducing health care emissions is not at odds with mitigating other challenges. Indeed, accounting for the environmental cost of care could be a catalyst for improving the wider sector.

I’ve heard many fellow healthcare professionals pride themselves on being environmentally conscious. Like me, they had no idea that their clinical decisions likely contributed far more to carbon emissions than their driving or cycling habits.

I recently interviewed two physicians, Jonathan Slutzman and Gregg Furie, who are leading environmental sustainability efforts at Mass General Brigham in Boston. They told me their work was met with enthusiasm and encouragement from their colleagues.

Physicians care deeply about the connection between the environmental impacts of clinical care and the downstream damage it has on human health, Furie said.

Slutzman added that being part of the solution can help deal with burnout. Hundreds of doctors across our healthcare system yearn for this type of work, she said. They feel satisfied with their employer when they know what they are doing and how they can participate.

Everyday decisions can have a big impact. I’ve written earlier about how reducing the use of desflurane, an anesthetic gas, can dramatically reduce hospitals’ greenhouse gas emissions. The alternatives are clinically equivalent, less expensive, and also have a small fraction of the global warming potential of desflurane. Two months ago, Scotland became the first country to ban the use of desflurane.

Another example: Metered-dose inhalers (MDIs) are commonly used for asthma and other respiratory illnesses, but they contain hydrofluorocarbon propellants, which are potent greenhouse gases. Americans use about 144 million MDIs annually, making their use the equivalent of driving half a million cars.

For years, Swedish medical societies have been working with doctors and patients to switch from MDIs to low-carbon alternatives, such as dry inhalers. Although MDIs make up 75 percent of inhaler prescriptions in the United States, they are now only 13 percent of Swedes, and Sweden produces superior clinical outcomes to the United States. Similarly, the UK’s National Health Service has launched an initiative to reduce the use of MDI which would reduce emissions and improve health outcomes.

This is the key point: there is no need for a compromise between the patient’s health and that of the patient health of the planet. Rather, understanding the environmental cost of treatment options can lead to more informed decisions that improve patient care in the short term AND reduce long-term environmental consequences.

Furie and Slutzman believe this approach is consistent with the drive for high-value care, which requires efficient use of resources to achieve optimal care for each patient. This, in turn, requires industry to quantify the environmental impacts of different interventions.

For example, Slutzman told me that researchers are currently studying the impact of different circumcision methods. While most parents who choose to circumcise their sons opt for the procedure within the first 48 hours, others do so much later. The former is quick, easy and uses little equipment; the latter may require an operating room, anesthetic gases and additional staff. If insurers don’t cover newborn circumcisions but do cover the procedure months or years later, they would incentivize the more resource-intensive option. Quantifying the environmental impact can help.

There will be circumstances where people will opt for more carbon-intensive treatments, either because they are better for patients or because they make more financial sense. But I think many people would think differently about their choices if there was an easily accessible environmental scorecard. I, for example, will replace my children’s asthma MDIs with dry powder and will be much more mindful when prescribing MDIs to patients.

After all, many people make climate-conscious decisions in other aspects of our lives. Why not give them the tools to do so when evaluating health care choices?

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