Translated from the original German version. This article discusses the symposium "Benefits through sustainability" which took place in the context of the German Society of Dermatology 2023 Congress (DDG 2023) in Berlin, Germany.
It can now be assumed that the limit of 1.5 degrees of global warming can no longer be met.1 This means that climate change-related health crises will also be increasingly felt in Germany. Therefore, the question has long since ceased to be whether health care systems should become more sustainable, but rather how quickly and how effectively sustainable measures can be implemented for everyday practice and clinical practice.
At the DDG 2023 symposium "Benefits through sustainability" it was clearly addressed that in dermatology there is already an incidence change due to climate change. In addition to a significant increase in skin damage and skin cancer caused by UV radiation, insect-borne infectious diseases, pollen-induced allergies, atopic eczema and autoimmune diseases are also spreading more and more in Germany.
In order to be able to ensure health protection in the future, practice and private clinic staff must also contribute to keeping society's carbon footprint as low as possible. However, many physicians are unclear about how to make their own practice sustainable. For this purpose, the DDG's Working Group Sustainability in Dermatology provides informative articles on the topic of climate change and medicine as well as numerous tips and online courses on sustainable practice management. Based on the information material from the dermatological practice application, we have compiled some practice-relevant information for interested physicians:
Sustainable practice management means making the practice organisation as climate-neutral and resource-saving as possible. Resource conservation implies not only the reduction of greenhouse gas emissions, but also economic savings in the area of practice management.
Despite legally prescribed requirements - such as hygiene regulations - fields of activity can also be identified in the medical sector that can be made sustainable step by step.2
In addition, sustainable practice management can motivate physicians as well as the practice team to adopt a sustainable lifestyle in both their professional and private lives. Medical practices that are actively committed to more sustainability are generally considered more attractive for medical assistants and are thus at an advantage as potential employers.
At 59.7%, medicines are responsible for the largest share of greenhouse gas emissions from medical practices.3 Polymedication and overuse are common problems, especially among older patients. Therefore, it is important to check the timeliness of long medication lists in order to avoid undesirable interactions.
Likewise, overprescribing and unnecessary equipment examinations should be avoided, not only to save resources that might be needed for necessary therapies, but also to act in a climate-friendly way.
Metered dose inhalers are the part of prescribed medicines that are most harmful to the climate due to the propellants used.4 For an average practice, the climate impact of metered dose inhalers is greater than the climate impact of the energy operation of the entire practice.3 Alternative powder inhalers should therefore be used.
At 22.8%, the purchase of materials accounts for a significant part of a medical practice's carbon footprint.3 Unfortunately, there are few climate-neutral medical products available so far, which is why medical practices are encouraged to rely on the principle of "reduce, reuse, recycle".
It is also important to pay attention to the way to the practice - both on the part of the practice team and the patients. Switching from car and public transport to cycling not only contributes to CO2 reduction, but also has positive effects on health.
Within the practice team, the possibility of promoting car pooling or obtaining a tax-reduced public transport ticket or company bicycle can be discussed. Savings of up to 40% are possible.3
Patients should be informed about the accessibility of the premises by public transport or bicycle, e.g. via the website of the doctor's practice, and secure bicycle parking should be provided. By improving accessibility by telephone and by offering online consultation hours, you save your patients unnecessary journeys.
Energy saving start with the smallest steps: LED lights, rechargeable batteries instead of disposable batteries, switching off appliances after use, etc. It is advisable to switch to green electricity and to choose a provider who also actively invests in renewable energy.
It is also possible to clarify with the medical practice's building management whether a connection to more sustainable heating sources, such as biogas or district heating, makes sense and is feasible. Just lowering the heating at night and on weekends makes a difference. There are programmable thermostats that can be installed on the existing radiators.
After successfully treading the path to climate neutrality in one's own practice, the question arises for many physicians: How can I make the sustainable practice visible?
In order to make medical practices both more sustainable and thus more attractive and to avoid greenwashing, the aQua Institute [translator's note: Germany-only focused] offers a "Sustainable Practice" quality seal for more climate protection, resilience and sustainability in health care. The offer is directly geared to the requirements of a medical practice and contains recommendations and measures that are integrated into everyday practice. To this end, the programme offers, among other things:
The quality seal is awarded to medical practices that demonstrably and systematically commit to training the practice team in the environmentally friendly use of resources and to informing patients extensively about the effects of climate change on the environment and their health.
The contents and requirements for obtaining a seal cover a total of four modules5:
The fields of action that must be taken into account in order to obtain the sustainability seal are: