Educating Patients as Medicine Goes Green

Abstract

CLINICAL CASE Educating Patients as Medicine Goes GreenCommentary by Louise P. King, MD, JD, and Janet Brown Ms. Chen had been going to Dr. Patel's outpatient gynecology practice for several years for her annual well-woman exam. The rural clinic was understaffed, and it was all the few participating physicians could do to manage the patient load.A few months before Ms. Chen's yearly check-up, Dr. Patel's small group practice instituted a policy to stop using plastic specula for gynecological exams. The clinicwide policy was an effort to reduce waste and avoid the increased shipping costs of plastic specula. Signs were posted in the clinic waiting area that informed patients of the practice's decision to "go green," and thanking them for their understanding and continued support.Ms. Chen preferred the single-use plastic speculum, however, for hygiene reasons. She did not want to get a sexually transmitted disease from an improperly sterilized instrument and requested a single-use plastic speculum for her exam. Dr. Patel informed her that the clinic no longer stocked them and reassured Ms. Chen that measures had been taken to guarantee the metal specula were properly sterilized. Commentary 1 by Louise P. King, MD, JD Dr. Patel and her small group practice should be commended for "going green"-a movement that has become common in both large academic centers and public hospitals. Experts estimate that U.S. hospitals produce an average of 6,600 tons of waste per day. Over the past 10 years, waste production has increased as much as 15 percent with the escalating use of disposable, single-use products such as plastic specula [1]. Much of our medical waste is incinerated, with the resultant release of noxious gases that many argue are detrimental to the environment [2]. Movement toward recyclable materials should be encouraged not only as a cost-saving measure for hospitals and clinics but also as a necessary change to alleviate some of the burden of medical waste.At the same time, Ms. Chen should not be faulted for expressing a fear, however unwarranted, that a change to a metal speculum would expose her to infectious disease. She is most likely unaware of the inherent safety of sterilization procedures. Perhaps Dr. Patel could educate her about this, which may or may not alleviate her fears. Ultimately, if Ms. Chen refuses an exam with a sterilized speculum, as the case asks, must Dr. Patel provide her choice of speculum? The answer is probably no.

“Green informed consent” in the classroom, clinic, and consultation room

“…While patients should be aware that their health care emits carbon, contributes to climate change, and may affect them through climate change health hazards, they should not bear the burden of research into the environmental effects of health care, as they are often in the vulnerable position of needing or seeking medical treatments and are not required to be experts in either medical care options or carbon emissions of health care. Therefore, patients may expect—and be prepared— for health care providers to disclose the environmental effect of various procedures during green informed consent, which is already the standard in some health care facilities (King and Brown 2009 ).…”