Doctors

Calling all doctors!

It might appear that greening the NHS is all down to hospitals’ Estates departments to install cleaner boilers, but think about it: doctors are the ones who draw resources through the NHS – by their clinical decisions. Doctors decide what appointments to arrange, which scans and procedures, what drugs to prescribe. Did you know that 22% of NHS total carbon emissions are attributed to pharmaceuticals? (see the NHS Emissions Modelling Report) Even the advice you give to a diabetic patient to walk to work and eat more vegetables could have a big effect on their personal carbon footprint.

Recently, some NHS Trusts have started to stir on things like saving energy and cutting waste. But doctors have not had much of a role – even though many are very knowledgeable and motivated on green issues.

I'm a doctor, what can I do?
Before you start, it is worth finding out what efforts are already underway at your workplace and how you can help. Speak to your Estates Manager (or practice manager) as a first step: there may be an environmental steering group you could join, or a travel planning committee, bicycle users’ group, etc.

But remember, as a doctor, you have several special roles with an important contribution to make:

clinician
controller of clinical pathways
respected advocate

The Clinician

Your patients are your first priority, and they listen to you on matters relating to health. The good news is: sustainable lifestyles are healthy!

Think about your patients and their:

physical activity
Getting around by walking and cycling is good for fitness and mental wellbeing, and reduces obesity and all its related conditions. Before starting a statin, what about prescribing regular cycling to work, or referring to a Green Gym?
Walking can be especially important for the elderly, in building up muscle strength and balance, maintaining mobility and independence. Find out more about walking as a health intervention from Walking the Way to Health.
diet
We can dramatically cut our carbon footprints by eating less meat and dairy (which require a lot of land, water and petrol to produce), and switching to a locally-produced vegetable-rich diet, containing fewer highly-processed foods. For most people, this would be a lot healthier too. The Food Climate Research Network has more on the climate impacts of food production.

housing
Have you ever waited to examine an elderly patient as they remove a third layer of underwear? Ever asked a patient with bronchitis if their home is cold or damp? Fuel poverty affects 3.5 million households in the UK, but those who need it most are often the last to seek help. Ask your patients’ permission to refer for a free home assessment by the local Energy Saving Trust advice centre or assessment for a Warm Front grant.

(Lots more information on the links between high carbon lifestyles and health at www.carbonaddict.org.)

The Controller of Clinical Pathways

The way our health systems are set up can sometimes require a disproportionate input of resources for the clinical benefit received.

Think of wasted clinic visits for test results not yet back, operations deferred on last minute discovery of co-morbidities, patients receiving overlapping care from diabetic, renal, cardiology clinics. Even the value of certain investigations or procedures in a patient care pathway is up for debate.

Arguably the greatest environmental savings for healthcare lie in lean service delivery - along with improved patient experience at reduced cost...

Set up a clinical audit to check that tests and follow-up appointments are actually contributing to patient management;
Write to your clinical director asking them to get "greening" onto all agendas (template letter below);
Look out for local efficiency gains and feed them back to the department;
Contact your specialty association: ask them to review the environmental impacts of clinical care pathways and national guidance (template letter below);

The Respected Advocate

When doctors speak about health issues, people listen. The environment is a health issue – here are two key reasons:

Climate change is an extremely serious threat to human health and survival
Policies for a low-carbon society bring prompt and compelling co-benefits to public health

Make sure the doctors on your Trust Board keep putting environmental issues on the agenda;
Make your voice heard in the local community on issues of transport, leisure services and planning;
Sign the Climate and Health Council pledge calling on governments of the world to take meaning ful action on climate change. The Council is working to collect 10,000 signatories of health professionals in time to influence the crucial negotiations in Copenhagen at the end of 2009.\
Write to your Royal College, Specialty Association, anything else you are a member of (template letter below);
Help set up a student-selected module in sustainable healthcare for your medical students (more info on The Climate Connection);
Ask drug companies what they are doing about carbon reduction – decline conference invitations and request remote video or tele-links.

Sources of information on climate change, health and co-benefits:

The Climate Connection - a resource for the action and learning on climate change and health
Carbon Addict - evidence-based guide to medical management of carbon dependence...
The Met Office - good background to climate change science and history
World Health Organisation – impacts on global health
Royal College of Physicians: "Climate Change and its Impact on Health" 29 Jan 2008 - listen to conference presentations
BMA resource page for health professionals - includes examples of good practice
The Climate and Health Council

Finally... Get in touch!
– let us know you’d like to help, and tell us your ideas for how our campaign could develop.