MEDICUS May 2022

How GPs can contribute to sustainable healthcare Dr Richard Yin Member, Doctors for the Environment Australia I n its position statement on climate change, the Royal Australian College of General Practitioners (RACGP) recognises the climate crisis to be a health crisis. 1 GPs have an important role in both mitigation and adaptation 2 and can demonstrate environmental leadership, embracing sustainability as part of a primary care ethos, and aligning it to quality care. From the consulting room through to the broader community, GPs have an important role in advocacy. The change towards sustainability requires not just considering energy use or waste but a fundamental re-evaluation of the purpose and practice of medicine, and an integration of sustainability thinking across all areas of operations. The healthcare sector in Australia contributes 7 per cent of Australia’s total carbon emissions. 3 General Practice accounts for 4 per cent of the total, excluding emissions from pharmaceuticals. While the non-clinical carbon footprint of practices is relatively small, as role models, we should embed advocacy within every aspect of what we do. Sustainability is not just a series of tick boxes but involves leadership and cultural change within workplaces that bring colleagues and staff on the journey. Carbon emissions from practice operations need to be audited to set a benchmark and a basis for future monitoring. There are numerous online carbon calculators that would provide guidance, and RACGP has a factsheet on reducing the Environmental Impact of General Practice ( https://bit.ly/3kuns85 ). UK data shows that energy use and staff travel are the main modifiable areas. These should be addressed first with consideration of purchasing green energy. 5 Estimates of the carbon footprint of General Practice in the UK suggest that 65-90 per cent are associated with pharmaceutical prescribing. 6 Extrapolating that to Australia would have the bulk of GP emissions lying within prescribing and clinical practice. Patient travel Services Total Staff travel Gas Electricity Electrical equipment Food and drink Paper towels and toilet rolls Medical supplies Printer and paper total Water Source: Sustainable and environmentally friendly general practice, BMA, June 2020. 4 Continued on page 27. Health resources need to be valued. Every investigation that we order and every medication that we prescribe has a financial and carbon cost. With up to 40 per cent of healthcare either of low value or detrimental, 7 there is considerable waste in clinical practice. Resources such as Choosing Wisely Australia 8 or the RACP Evolve 9 initiative are helpful in offering a framework to reflect on quality clinical practice. By choosing health interventions with low environmental impacts, such as lifestyle interventions and psychosocial interventions before pharmacotherapy where appropriate, and reviewing and “deprescribing”, we are not only practising good holistic care but also following the principles of sustainable care. The RACGP Handbook of Non-Drug Intervention (HANDI) 10 is a good resource for options to pharmaceutical prescribing. One key carbon hotspot that deserves special mention is the use of metered-dose inhalers. The propellants used within them are potent greenhouse gases. Many patients can be effectively switched to dry powder inhalers without adverse clinical outcomes. M AY 2 0 2 2 M E D I C U S 25 C O V E R S T O R Y – C L I M A T E C H A N G E A C T I O N