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Ophthalmologists can try to lead by example to reduce carbon footprint
The regulatory challenges facing the practicing ophthalmologist today are enormous and continue to grow in number and complexity. I consider our practice, Minnesota Eye Consultants, to be forward thinking, perhaps even visionary, in its relentless effort to not just survive but thrive in an ever more challenging heath care environment. My partners and management team are dedicated and driven to provide quality care to our patients in a high-tech, high-touch environment designed to generate great outcomes and highly satisfied patients. We are also committed to delivering ever better care for an ever decreasing cost per unit of care, providing a great value to our patients and community. Never once in my nearly 40 years of practice have I or the multitude of local, state and federal regulators that monitor our performance ever mentioned any concern with the carbon footprint our practice generates while pursuing the triple aim of quality care, satisfied patients and reduced cost. I therefore find myself ill-prepared to comment on this topic but will still attempt to share a few thoughts.
A carbon footprint, according to Wikipedia, is defined as “the total set of greenhouse gas emissions caused by an individual, event, organization or product expressed as CO2 equivalent.” Most calculations include, on top of carbon dioxide, the methane emitted as well. The major geopolitical relevance is the role these greenhouse gases play in pollution and global warming. In the practice of medicine, most of the carbon footprint is indirect, meaning from fuel burned and carbon dioxide and methane generated manufacturing the products we use and, probably of most importance, from the fossil fuels used to generate our electricity, heat our facilities and especially to transport us, our employees and our patients to the offices, surgery centers and hospitals where we provide our services.
What, if anything, can we as ophthalmologists do to reduce our carbon footprint? The overarching guidelines are to reduce product use, recycle, reuse products when possible and refuse products with high carbon footprints. Reducing product use is rarely possible without compromising quality of care, and government regulations require high carbon footprint packaging, including multipage product package inserts. I see little we can influence in this regard. Recycling is definitely possible, and this is something that everyone can support both at work and at home. Reusing products is definitely in opposition to nearly all of our certifying regulatory bodies, which are constantly encouraging us toward single-use disposable products. Many of us remember 20 or more years ago when all drapes, gowns and the like were reusable and washed and replaced into use hundreds of times. I have not seen a reusable drape, gown, cap or mask in any ASC or hospital in more than a decade. If one existed, the first regulatory review would demand it be replaced with a sterile disposable alternative. I see no chance this will change any time soon. Refusing to use high carbon footprint devices is usually not possible, except for being active in one’s community to advocate for sources of energy that do not burn fossil fuels in their generation.
The majority of the fossil fuels burned in the practice of medicine are in the transportation of doctors, employees, product suppliers and patients to the clinic, ASC and hospital. It is beyond our power to mandate what kind of car or truck our product suppliers or patients drive or how far away they live, but we can do our best to reduce unnecessary transportation distance and frequency. Expansion of telemedicine and at-home diagnostics might help. In addition, as one example, adopting same-day sequential cataract surgery would halve the number of operative and postoperative visits required. With 4 million cataract operations and four visits per procedure per eye and an estimated 10 miles each way for transportation, that one change could reduce the number of miles driven by our patients and their caregivers for cataract surgery from 320 million to 160 million. At 20 miles per gallon of gasoline, that would save 8 million gallons of fuel. Burning a gallon of gasoline generates about 18 pounds of CO2, so switching to bilateral sequential same-day cataract surgery would reduce greenhouse emissions by as much as 150 million pounds of carbon emissions per year in the U.S. alone. The reduction in travel required would also prevent more than 600 car accidents, eliminating many severe injuries and two fatalities each year.
We ophthalmologists are certainly part of the global community as a whole, and concern regarding greenhouse emissions and their impact on global warming is real. Still, it seems unlikely that any changes we make will impact this global challenge in a meaningful or significant way. I must admit this topic has not yet surfaced in any partner, hospital staff or educational meeting I have ever attended. Nonetheless, we ophthalmologists can get educated about the issue and try to lead by example, attempting to reduce waste, recycle when possible, reuse products when allowed, and refuse products with high carbon footprints when there are equally efficacious alternatives with fewer greenhouse emissions.