Green

Coming from Stanford and San Francisco, I've been somewhat attuned to sustainability. We have a fundamental responsibility to preserve intergenerational equity and maintain environmental potential. Yet nearly all of us live in an unsustainable manner. We consume without regard to future generations. The impact on the environment is unjustifiable; not only are we destroying the atmosphere, oceans, freshwater, forests, land, ecosystems, and biodiversity, but we are also causing detrimental effects on human health. I believe our technological, medical, industrial, agricultural, and other advances have allowed us to extend the carrying capacity of our environment but beyond the limit of sustainability. Hence, there are movements for global awareness, sustainable living, renewable energies, responsible food production, green design, etc.

Recently, I've become interested in integrating sustainability and medical facilities. On my clinical rotations, I've realized how many resources are used in an environmentally unconscionable manner. For example, even a simple outpatient surgery uses incredible amounts of disposable materials. I like to focus on towels. After scrubbing - disinfecting my nails, hands, and upper arms before a surgery - the scrub nurse hands me a sterile towel. Carefully, I dry my arms in a prescribed fashion preserving sterility and then throw the towel away. I don't understand why; the towel merely dried off my antimicrobial soap slathered arms. There's no blood, no body fluids, no MRSA bacteria. Why can't they be re-sterilized and reused?

I imagine putting towel reuse bins in every operating room might save a bit, but honestly, it wouldn't put a dent in the amount of waste a hospital generates. To me, this example reflects the unfortunate mentality that pervades the hospital. Until recently, sustainability was not on the radar. People did not think about it. We were above it. After all, we're "saving lives." We have to use what it takes. When you look at the ethical principles of beneficence, doing right for the patient, and justice, providing equal care to all, beneficence wins out. Practitioners rarely think of justice and rarely interpret it as providing equal care to those patients in the far future, when resources may not be as plentiful.

When I was on ob/gyn, one of my attendings told me that in China, doctors can do a hysterectomy with four pieces of suture, the material used in surgical stitches. That's incredible. I don't know how much suture we use in a typical operation, but it's certainly much more than four. The reason? Some hospitals in China have patients purchase their own surgical supplies, and as a result, practitioners have figured out the maximum efficiency to minimize waste. Consumers demanded it. But in the U.S., I've not seen such pressure to minimize resource usage.

The big picture, however, is not in how many disposable gloves or masks I use (though I try hard not to waste anything). Many of the hospitals I've seen are old, built decades ago, without technology that saves energy, reduces waste, or operates efficiently. To really move toward green hospitals, we need to look at how electricity is distributed, how heating and cooling systems are managed, how we can provide optimal care with the least carbon footprint. Hospitals generate so much waste, and much of it is toxic and hazardous, but much may also be excess. How do you maintain sterility without double or triple or quadruple packaging materials? Can we dispense with overflowing, unorganized paper charts (much of which is illegible anyway) to save paper, reduce shredding costs, and free up physical space in medical chart storage? Can we build hospitals that employ green architecture, taking advantage of sunlight, ventilation efficiency, sustainable building materials, and responsible energy production methods? Who are the administrators that need to approve this? Who are the engineers that need to work this out?

This needs to happen; there's no question. Everyone, everywhere needs to change in order to preserve the limited resources of our planet, and hospitals are no exception. They are behemoths to move, but I hope my generation of physicians, administrators, practitioners, and thinkers can loosen the inertia and begin planning how to go green without compromising patient care.