Healthcare and the Environment

By: Shane Williams, MD

Recently while in the OR assisting a C-section, I began to discuss the benefits of different instruments and techniques with my attending. I noticed that he was choosing to use a wound protector/retractor instead of manually retracting with other instruments. These wound retractors are one-time use instruments made of rubber and plastic consisting of two rings connected by a film tube. The attending stated a number of benefits to this device, describing the hands-free nature of its use and the better visualization of the surgical field. I noticed that he didn’t mention a single drawback of its use compared to manually retracting with reusable instruments. When I asked him what advantages manual retraction might have, he stated that one of his colleagues does not use the rubber and plastic retractors because of their increased carbon footprint. He proceeded to scoff at this idea and continued with the C-section. It was clear that he thought this was a ridiculous consideration and that he had no plans to make changes based on environmental impact.

The healthcare system in the US has a staggering environmental impact as a whole. A 2016 study published in PLOS ONE by Matthew Eckelman and Jodi Sherman found that, in 2013, the health care sector was responsible for significant fractions of air pollution emissions and impacts in the US resulting in 470,000 DALYs (Disability-Adjusted Life Years, a measure of the number of years lost because of poor health, disability, or early death) (1).

I started questioning my own contributions to our system’s negative environmental effects and how I could make a positive impact through my own habits. As we become increasingly aware of our individual environmental impact and the concern over climate change and pollution grow, how do we begin to make changes that improve our environment without sacrificing patient care?

One of the major concerns I could see with making these changes is that we would sacrifice patient outcomes in favor of protecting our environment. It is easy to say that making the best medical decision for an individual patient is the only thing that matters and no other factors should affect our decision making. However, we frequently make decisions in health care based on other factors. We are taught to consider the costs of lab tests, imaging, and medications when developing our plans and balance this with the expected patient outcome. This is considered good medicine. We are frequently forced to sacrifice patient outcomes and preferences and provide less than ideal alternatives because of patients’ insurance coverage and financial situations. However, we don’t typically consider the “environmental cost” of our decisions. We don’t weigh the patient outcome against the carbon footprint of our care.

Yet this may be one of the most important factors we could consider when caring for our patients on a population scale. We are contributing heavily to pollution and having a direct negative impact on the health of our patients. This is a public health issue that we are directly responsible for. If we really want to improve the health of our patients in the future, we need to begin working on cutting our environmental cost as a system. We can start by making our own small changes to our practice, but eventually we will need to change our entire culture if we want to prevent the hundreds of thousands of years of lives lost due to our environmental impact.

  1. Eckelman MJ, Sherman J. Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PLoS One. 2016;11(6):e0157014. Published 2016 Jun 9. doi:10.1371/journal.pone.0157014

Shane Williams, MD, is a first-year intern in the Division of Family Medicine at the Department of Family and Preventive Medicine at the University of Utah in Salt Lake City, UT. His medical interests include care for underserved populations, wilderness medicine, and medical education.

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