David Pencheon: What is it about large scale change that makes anaesthetists act?

David PencheonChange may be the new constant, but it is always important to understand who embraces change most readily, and where. Doctors in general are traditionally conservative, as those outside the profession will be only too happy to confirm. We like to think we pioneer change both via behaviour (witness the change in smoking prevalence amongst doctors in the UK that preceded the change in prevalence in the wider population) and via technology (transplants, genetic research, new drugs). The resistance many doctors are showing to the current NHS reforms in England, suggests we are less engaged with that third pillar of large scale change: governance; the rules, regulations, laws, and incentives that determine how the system runs.

The first pillar (behaviour) is always the most challenging and seems heavily influenced by context: we turn the lights off at home when not needed and take great care to recycle where possible. However, when we are in a hotel, a conference, a hospital, or a health centre, our behaviour rarely lives up to our domestic habits, despite knowing the long term (if not the short term) consequences are exactly the same. It only takes good people to do too little for bad things to happen; such is the power of setting an example, together with the creative ways we all rationalise our own behaviour: (“if smoking were that dangerous, my doctor wouldn’t smoke” and “if climate change really is the greatest health threat we face, then doctors would surely take more action”).

Well, some doctors do take action: in practical and significant ways. I am always impressed how many anaesthetists take the issue of sustainability and climate change so seriously, for example. Why? Is it because they are exposed to so much non-recyclable waste generated in operating theatres every day? Take a recent letter by Shelton and Rothwell referring to a 2 month audit of waste in an English hospital. Not a glamorous topic? Local recycling companies (with an eye to profit no doubt) seem very enthusiastic. These authors showed beautifully (and quantitatively) how behaving more sustainably can deliver better patient care, protect the future, and save money today.

This is the sort of action Margaret Mead referred to when she said: “Never underestimate the power of a few committed people to change the world. Indeed, it is the only thing that ever has.” These are committed people doing more than most of us: trying to understand the balance of good and harm by looking, asking, measuring and advocating change. There will always be those who say safety comes first; and they are right. We must understand how dangerous it really is to use resources as though there were no tomorrow – otherwise that is exactly what will happen.

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David Pencheon is a UK trained public health doctor and is currently director of the NHS Sustainable Development Unit (England).