Was asked a question about this… I don’t know the answers….but others did
The obvious overlap with and learning from green nephrology?? (and green everything else)
The clever work comes from Frances Mortimer, a wonderful renal reg who (apparently) woke up one day and decided to save the species instead of the kidney. She worked for ages for the campaign for greener healthcare (Muir Gray backed project based in Oxford) – think she’s still part of this work.
Web link is http://www.greenerhealthcare.org/
Link describing nephrology work.
There was also a greener ophthalmology movement that started with a keen ophthalmologist (think from Brighton but can’t remember) http://networks.sustainablehealthcare.org.uk/networks/eye-care-susnet/carbon-sustainable-ophthalmology
Probably all sorts of other green …..ology networks
Palazzo, S., Jirillo, A. & Mazurek, M. Green oncology: cultivating sustainability in medical oncology. Journal of gastrointestinal cancer 43, 20–23 (2012).
Mainly a narrative, agenda setting article.
Some useful looking bits and bobs. With a few “thy”, “thee” and “thous” it would almost be biblical……
Eleven items are listed in the paper:
- plastic devices shall be employed at the lowest possible level
- to reduce the economic burden, risk sharing and payment by results shall be promoted, drug day therapy shall be introduced wherever possible, and drug remnants from vials shall be utilized as much as possible
- biosimilar drugs shall be employed as soon as their efficacy and safety have been demonstrated
- optimal methodology by centralizing all cytostatic drug preparations shall be implemented to minimize the teratogenic, mutational and carcinogenic risks
- oral chemotherapeutic treatments shall be used as soon as applicable, to reduce the transportation of patients and avoid air pollution14
- e-mail or Internet communication and video calls with other clinicians and patients shall be promoted, complementary to the personal doctor-patient relationship
- clinical follow-up shall be reduced, based on evidence and clinical guidelines
- the biopsychosocial model shall replace the biomedical model
- training and educational events shall be offered online whenever possible
- overtreatment shall always be considered unacceptable, as it poses a threat to patients and health care workers without any evidence of an advantage to patients
- primary cancer prevention and an ecological approach to all clinical activity (with waste separation, recycling, use of nontoxic detergents, etc.) shall be implemented.
Other ideas that cropped up
- emphasise the importance of everything along the pathways
- Estates – waste, energy use, etc
- Procurement – food, FSC certified paper, minimum plastics, ethical medical supplies (may seem like a tenuous link but to cut a long story short if medical tools come from a sweatshop with profits going to arms trade in conflict zones then it’s very bad news, with repercussions on environmental behaviour)
- Recycling – ideally lots of different types and local
- Good corporate citizenship – is there scope for creating community spaces in the hospital (e.g. nottingham had a great guy who developed a cafe in the hospital that also made profit for the hospital then turned it into a community asset)
- ask the patients what they want, don’t treat because you can
- Low value treatments burn carbon and money for little to no discernible gain. Marginal oncology anyone?
- Of course greenest of all is avoiding diagnosis – either by preventing disease (remember that!) or by avoiding overdiagnosis etc…. hard when govt policy & daily mail explicitly pitch us in that direction..
- Also lots of stuff coming out about buildings needing to be thermally appropriate rather than thermally efficient. Particularly for vulnerable patients.
Finally – What about building the monetised carbon cost into cost benefit equations in addition to financial cost. Would change the nature of the return on investment calculus.
This to Yannish Naik, Frank Swinton and Jason Horsley
Just a few ideas