Good clinical practice can be high quality and low carbon

I feel privileged to Chair the RACGP Expert Committee Practice Technology and Management, who’s remit addresses some of my true passions – innovative technology and environmental protection through positive business approaches.
 
According to the Wiser Healthcare research collaboration, healthcare accounts for 4–5% of global greenhouse gas emissions. In Australia that figure is higher at 7%. The impact of resulting climate change on physical and social health are significant and broad.
 
While I’m a big believer that the greatest positive impact must come from legislative changes that support a greener future, we as individuals and as businesses can still play a significant role.
 
Personally, I’ve long been an adopter of and advocate for ‘green technology’, including using solar (I’ve had rooftop solar on my home for more than 15 years) and I am soon to install a solar battery at home. I have used an electric vehicle (EV) for more than 10 years and have now travelled 200,000 km using solar power from my home.
 
Due to renting our practice premises we are not able to use solar and batteries, but I would advocate for this as a great means of ensuring resilience of practices that are able to have them.
 
Installing solar power and storage is a long-term cost saving measure as well as an environmental benefit.
 
Solar rebates (and more recently solar battery rebates) continue to be available in most states and territories for both homes and businesses, for owners, and in some cases renters, and I encourage all practices to investigate this option.
 
A practice’s emergency response plan could include using battery stored solar power or an EV as a backup power supply as an alternative to a generator during an outage or in an emergency or disaster situation.  
 
Return on investment times for solar panel installations is now only a few years due to dropping prices of panels and increased electricity prices – but batteries, even with subsidies, may take longer.
 
However, the cost saving during power outages, and the effect on practice income during these times, may improve the balance in favour of batteries.
 
Minimising power usage will benefit a practice’s bottom line and the environment. There are many power saving initiatives that can be considered (for example, installing LED lighting and heat-pump electric hot water heaters) that are extremely energy efficient.
 
Adoption of green technology aside, there are so many ways, both clinically and non-clinically, where we can reduce our impact on the environment.
 
Reviewing the RACGP’s Environmental sustainability in general practice and implementing some of the key outlines actions for an environmentally sustainable general practice is a great kicking off point to minimising our environmental footprint.
 
Many of these actions are transferable to the home and many have the added bonus of reducing practice overheads in the long run.
 
The simple practice of providing high quality care may be one of the most direct ways to reduce carbon emissions within our sphere of influence by reducing unnecessary or low-value care (cited by Braithwaite, Glasziou and Westbrook as being 30% of care with an additional 10% of care deemed harmful). 
 
This low-value care may be through overuse of tests, overdiagnosis and overtreated conditions, or use of interventions with insufficient evidence.
 
Developed by the RACGP Expert Committee – Quality Care, the First Do No Harm: a guide to choosing wisely in general practice resource is an evidence-based resource with a primary focus on reducing patient harms and avoiding low-value care. 
 
If you haven’t used this before, I highly recommend a read.
 
A surprisingly significant contributor to greenhouse gas emissions is the humble asthma puffer. The primary culprit being hydrofluorocarbon propellants used in pressurised metered-dose inhalers (pMDI).
 
Asthma Australia’s National Sustainable Asthma Care Roadmap notes that of the 25 million inhalers sold in Australia each year, 80% are pMDIs, which are estimated to contribute more than 600,000 tonnes carbon dioxide equivalent (CO2e) emissions – similar to the emissions of 350,000 vehicles or 45,000 households.
 
But ‘green’ (low carbon) options are available, including dry powder inhalers (DPI) which do not require propellants.
 
To help guide us in supporting high quality but low carbon asthma management, the roadmap lists some of the inhaler options available in Australia by class, with estimates of the footprint per inhaler and the PBS restrictions.
 
Another great innovation that reduces the carbon footprint of medical care is the appropriate use of telehealth and assisting digital solutions.
 
This can dramatically reduce the need for patients to travel to medical appointments (and the subsequent generation of carbon emissions in the process).
 
Many of the recent digital solutions such as eScripts and eReferrals can also reduce unnecessary travel as patients no longer need to collect physical scripts or referrals from the practice.
 
Effective use of My Health Record has the potential to reduce unnecessary repeat testing.
 
Last month, World Environment Day was celebrated with this year’s theme ‘beating plastic pollution’.
 
Taking inspiration from this theme, at our practice we try to reduce the use of single-use or disposable equipment where possible and recycle when we can.
 
We also try to reduce the unnecessary use of some items such as gloves. For example, gloves are not necessary to examine a patient unless examining certain areas of the body (for example pelvis, mouth or areas with broken skin or discharge).
 
There is no need to don gloves to conduct a routine skin examination or a chest or abdomen examination in most situations, with appropriate hand hygiene of course.
 
While so much in this world is out of our personal control, let’s focus on the things we can do to positively impact planetary and human health. 
 
There have been some great positive changes made, and we need to keep supporting things such as renewable energy and reusable products, or products and practices with low impact on the environment.
 
If you are interested in joining with others who share a passion in this area, consider joining the RACGP Specific Interest Group Climate and Environmental Medicine or Doctors for the Environment Australia.
 
The RACGP has developed a suite of climate change and health resources for members, including the Environmental sustainability in general practice resource, CPD offerings, posters to display in your practice, as well as outlining our commitment to and actions towards a greener future.
 
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