Pat Lok: How can I be an environmentally conscious healthcare practitioner?

Pat Lok considers what medical students can do to reduce the impact of healthcare on the climate

“It is hot out there so please remember to keep hydrated for your renal health.”

That was the first time I heard weather mentioned in a patient’s consultation beyond just small talk. In fact, the effect of the weather on our health is no longer just small talk.

Our planet is choking and systemically unstable. If Earth were a patient, we would be pouring in as many resources as possible to stabilise it. Yet, we have left the alarm bells ringing with our inaction. Climate action at the individual level is commended, but we need a systemic change in implementing a sustainable model of healthcare.

I identify with the six in 10 young people who have anxiety about the climate. I worry about how climate change might alter the distribution and presentation of diseases in future. Increased rates of Lyme disease in the UK may foreshadow the potential shift in zoonotic diseases, as warming temperatures prompt vectorborne diseases to move north. Air pollution will exacerbate respiratory conditions such as asthma and chronic obstructive pulmonary disease, as evidenced by the death of 9 year old Ella Kissi-Debrah. Frequent bouts of heatwaves will increase the strain on cardiovascular health, putting at risk 7.6 million people with cardiovascular diseases in the UK.

As a medical student, the impact of healthcare on the climate emergency is a dilemma I need to face if I am to become an environmentally conscious healthcare practitioner. Every time I don personal protective equipment (PPE), I worry about the clinical waste that is generated, how it is treated with heat and chemicals, and the residue that could work its way back into our environment, in turn affecting our health.

The climate emergency infiltrates every facet of medicine: affecting our patients, our clinical practice, and the wider healthcare system. So what is being done to counter this?

Despite the General Medical Council listing “sustainable healthcare” as an objective in its guidance on Outcomes for Graduates, a discrepancy remains in the integration of this in medical school curriculums. Planetary Health Report Card, a student led initiative that examined the incorporation of climate change sustainability in the medical school curriculum, reported stark variation in the levels of coverage. Most medical schools scored an overall C, indicating that the gap in the curriculum to reflect climate change and sustainability has yet to be addressed.

Is our healthcare infrastructure resilient enough to provide safe care for our patients? The flooding at Whipps Cross Hospital in August 2021 after a sudden spell of heavy rainfall led to ambulances being diverted to other trusts and the cancellation of operations. Will we need to deal with these challenges on a more regular basis?

What can medical students do now?

Medical students can take action on clinical placement and in medical school.

One in 11 people in the UK currently receives treatment for asthma, and metered dose inhalers (MDIs) are commonly offered to patients for prophylaxis and management. However, MDIs contain a powerful greenhouse gas and can contribute to global warming. When going on placement, medical students can take the opportunity to check a patient’s inhaler technique, and educate patients about the consequences of improper technique, for their own health and that of the planet.

On anaesthetic rotations, students can start a discussion about the use of anaesthetic gas. Desflurane is among the gases most commonly used, but it’s also one of the most environmentally unfriendly. A lower carbon alternative—sevofluraneis available, but standardised approach is limited, as in practice choice of anaesthesia is influenced by patient, surgical, and anaesthetic factors.

Quality improvement projects are integral in the training of medical students and junior doctors. The Centre for Sustainable Healthcare (CSH) has developed a toolset with the Royal College of Physicians that recognises the value of integrating sustainability into quality improvement. Not sure where to start? The CSH has compiled a bank of case studies of projects that are happening across the country.

Climate change compounds existing health and social inequalities. We can talk to patients about climate change, but we need to acknowledge that some climate friendly actions may not be accessible to all patients.

The potential zoonotic origin of SARS-CoV-2 virus has once again highlighted the intimate relation between animal and human health. We should work with our veterinary colleagues who tackle similar problems in terms of healthcare and sustainability. Some veterinarians have done amazing work in using sustainable PPE in clinical practice.

There are several student led groups in the medical field with one united voice: climate change is here and we need to take action now. The only missing piece is the systemic change in making this process smoother and easier for practitioners and patients alike.

The evidence is unequivocal. As practitioners of evidence based medicine, we need to use our voices to persuade stakeholders and policy makers to enact change for a sustainable healthcare system.

I’m not a fan of small talk, but I’d rather be making small talk about the weather than including it as a factor that will significantly affect my patient’s health and safety.

Pat Lok is editorial scholar at The BMJ, and a medical student at Anglia Ruskin University.

Competing interests: PL worked at the Met Office as a summer placement student in summer 2018.