From new plant-based hospital menus to surgical gloves and disposable syringes, medical professionals are finding ways to combat waste and pollutants.
Dr. Wendy Levinson, president of environmental advocacy group Choosing Wisely Canada, said doctors are changing their practices to reduce the environmental impact of almost everything from lab tests to medications. .
“What's new is that medical professionals are starting to say, 'What can I do?'” said Levinson, who is also a professor of medicine at the University of Toronto.
Her group has published 40 recommendations from doctors from a variety of specialties encouraging individual and collective action on climate change, including reducing clinical testing wherever possible; This includes holding virtual meetings to avoid excessive travel.
Similar initiatives, large and small, are underway across the country.
The recently concluded Planetary Health food pilot at Vancouver General Hospital put plant-based meals and “climate-smart proteins” such as steelhead trout and turkey on patient menus, says the six-month project. said Dr. Annie Lalande, who focuses on hospital food. and food production.
The show featured lunch and dinner options that incorporate sustainable and primarily locally sourced ingredients, such as coconut chicken curry, soy sauce-based sulu joes, and Korean gochujang rice bowls made with beans.
The recipes were developed with input from patients, and the program recently expanded to Richmond General Hospital in south Vancouver.
Lalande, who earned a doctorate in environment and sustainability from the University of British Columbia while completing his surgical training, believes there is a disconnect between human health and the environmental impact of raising animals, especially beef cattle. He said there was a clear connection.
“People are starting to understand the role that food plays in both our health and the health of the planet. The main objective of this project was to consider food from the perspective of greenhouse gas emissions.” she said.
“We're trying to maintain choice for our patients, but we're definitely not trying to make everyone vegan,” Lalande said, adding that before the new menu was introduced, the maximum amount of food on patients' plates was He added that half of the food was left uneaten.
The sustainability initiative by Choosing Wisely Canada, which also includes Toronto's St. Michael's Hospital, focuses on reducing “low-value” laboratory tests, treatments and procedures.
GPs, pharmacists and about 24 professional societies made the 40 evidence-based recommendations published this week. This is part of a campaign funded by the Canadian Medical Association Foundation, Health Canada, and all provinces and territories except Quebec and Yukon. Part of the funding is provided by the former Québec Medical Association.
This recommendation encourages physicians to order blood tests only when necessary, rather than scheduling them regularly, to reduce the use of disposable tubes and syringes. They also point out that antibiotics are often prescribed for viral infections, despite evidence that they are ineffective against them, and urge caution when prescribing drugs. I'm looking for it.
Many of the recommendations are simple and practical, including those put forth by the Canadian Critical Care Association, which urges intensive care unit staff to avoid using gloves when proper hand washing would suffice.
“In the ICU, we use 100 pairs of gloves per patient per day. People wear gloves all the time, even when they walk into a room and press a button on a machine,” Levinson said.
“Of course, it goes beyond critical care. We're throwing away millions of gloves.”
The Canadian Orthopedic Association's recommendations call for operating room staff to separate uncontaminated waste from materials that are contaminated and must be incinerated, emitting more greenhouse gases.
It is also recommended that metered dose inhalers should not be prescribed to patients with asthma or chronic obstructive pulmonary disease (COPD) if possible, as they emit greenhouse gases called hydrofluorocarbons (HFCs) into the atmosphere. has been done.
There are about 35 types of inhalers available in Canada, some of which are L-shaped metered-dose types, said Dr. Val Stoynova, an internist in Victoria who co-authored the Canadian Society of Internal Medicine recommendations.
“When you press the canister, the gas that comes out is the gas that propels the drug into your lungs. That gas is very carbon-rich and, depending on the type and amount of propellant, each metered dose inhaler is actually the same “A typical vehicle uses gasoline and travels up to 170 kilometers a day,” she said.
Metered dose inhalers should also be incinerated as medical waste to neutralize any remaining propellant.
A lower-carbon, cheaper alternative called a dry powder inhaler doesn't contain propellants and would emit as much carbon dioxide as 2 to 5 kilometers per day, Stoynova said.
Follow-up with standardized tests shows that about one-third of Canadians diagnosed with asthma in a laboratory setting do not actually have asthma, and nearly twice as many are mistakenly diagnosed with COPD. It turned out, she said.
“They are being prescribed inhalers for illnesses that they may not have, but these are inhalers that they don't actually need to use,” Stoinova said, adding that short-acting devices He added that side effects of the drug can include anxiety, which can be long-lasting in some cases. Actuated inhalers contain steroids and carry the risk of infection, hoarseness, and fungal infections of the throat.
But patients shouldn't be made to feel guilty for needing an inhaler to manage a chronic disease, she says. Children under the age of 6 and those who are frail or disabled lack the coordination to use dry powder inhalers, she said.
The idea is for doctors and patients to work together to discuss the pros and cons of unnecessary procedures, said Tony Leamons, one of four patient advisors who provided input on Choosing Wisely's recommendations. He said that this does not preclude people from receiving the care they need. .
“I think there is good value for the environment in these recommendations. Patients should be involved because they are the users of the health care system,” Leamon said from Port-au-Basque, New Jersey.
The advisory also recommends virtual appointments whenever possible, and Leamon said driving to a major medical center in St. John's, New Jersey, 900 kilometers away, would emit large amounts of carbon dioxide and other pollutants. He said that's especially good for rural residents like him.
Many doctors, nurses and other healthcare professionals are joining hospital “green teams” to increase awareness of waste.
Dr. William Silverstein, a general internist at Sunnybrook Health Sciences Center in Toronto, said a Green Task Force launched at the center two years ago has focused on issues such as waste reduction.
Medical students are also learning about climate change advocacy as part of Choosing Wisely Canada's program called STARS (Student and Trainees Advocating for Resource Stewardship). Silverstein helped launch the program in 2015 while in medical school.
We will enroll two students from each of the nation's 17 medical schools for a year, and in the fall we will hold virtual conferences where students will learn how to advocate for change. This year, they received information about the harms of metered dose inhalers and prescribing alternative options.
Silverstein said three virtual conferences will be held throughout the year so students can network and discuss projects they have started and ways to improve the curriculum, and participants will be able to learn about the program. It added that you can receive a Choosing Wisely Canada certificate at the end.
The goal is to train the next generation of doctors to “do the right thing,” Silverstein said.
“Ultimately, this is a health care system where they are the stewards.”
The STARS program is being implemented in eight countries, including the United States, Brazil, Japan and New Zealand, and discussions are currently underway with medical schools in Switzerland, Silverstein said.
This report by The Canadian Press was first published May 17, 2024.
Canadian Press health coverage is supported through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
Camille Baines, Canadian Press
