Physicians Must Respond to Climate Change: An Interview With ACP President Damle

Laurie Scudder, DNP, NP


May 20, 2016

Editor's Note:
The American College of Physicians (ACP) recently released a position statement emphasizing that climate change poses a catastrophic risk to human health, including more respiratory and heat-related illness, vector-borne diseases, malnutrition, and behavioral health problems, and stating that physicians have a crucial role to play in fighting it. In support of that position, the College released a toolkit to help physicians both advocate for effective climate change adaptation and mitigation policies and educate their communities. Medscape spoke with Nitin Damle, MD, MS, current ACP president, about the toolkit. Dr Damle is a practicing internist and senior/managing partner at South County Internal Medicine in Wakefield, Rhode Island, and a clinical associate professor of medicine at Alpert Medical School, Brown University. He also spoke about changes that he has initiated in his own practice to address this serious public health issue.

Medscape: Why should the ACP take on climate change? Some physicians have suggested, given how busy they are with a huge array of clinical issues, that this is not an issue that they can or should tackle. Why do physicians need to take this on?

Nitin Damle, MD, MS
Image courtesy of Kevin Berne

Dr Damle: It's not really global climate change that we are addressing. We are addressing the health effects of global climate change. At ACP, we consider climate change to be a human health issue. Beyond any political or economic ramifications, it is an important issue for the care of our patients. The effects of global climate change are being felt now. We are seeing a longer season and more severe allergy symptoms. There is also an increase in respiratory illnesses and tick-borne and water-borne infectious diseases. In addition, there are heat wave-related illnesses and food insecurity in some parts of the world. These changes are not in the distant future; they are happening as we speak. It's important for us to try to educate the public, our patients, and our colleagues about the human health effects of global climate change.

Medscape: From a clinical perspective, what can physicians do today in their practices to address these health effects?

Dr Damle: Climate change has resulted in longer allergy seasons, more pollen, and more allergens generally in the air. These changes cause a significant amount of distress for patients—rhinorrhea, conjunctivitis, general discomfort, and an increased risk for sinusitis and upper respiratory tract infection. Climate change can affect people with chronic diseases, including cardiac disease, asthma, and obstructive pulmonary disease. Increased incidences of exacerbations of these conditions can lead to more emergency department visits and hospitalizations. These are the health effects of air pollution, ozone pollution, and global warming.

Medscape: A recent study in the journal Temperature[1] looked at the ability of individuals with diabetes to self-regulate their body temperature and postulated that extremes of temperature could be enough to tip someone with well-controlled diabetes out of control. Do you manage your diabetic patients differently as a result of climate change?

Dr Damle: Like hypertension, once diabetes is diagnosed, it is a life-long chronic condition. Many factors contribute to blood sugar control in diabetes, including extremes of weather. Heat exhaustion, heat prostration, and heat stroke can place diabetic patients at risk for episodes of hyperglycemia or hypoglycemia.

Medscape: Do you manage patients with chronic diseases differently in the summer? Has climate change affected the way you manage these patients?

Dr Damle: We are more aware of the health consequences of climate change for patients with diabetes, chronic obstructive pulmonary disease, asthma, or allergies. Patients who don't have air conditioning in summer or have no place to go during a heat wave are more vulnerable to the health effects of climate change. We make these patients aware of their risk when severe climate changes (eg, heat waves, drought, floods) are anticipated and discuss the steps that they should take to prepare. Depending on where they live, patients must take precautionary action so that they do not find themselves in an unstable health situation.

We make sure that patients with chronic conditions are optimally controlled and that they have adequate supplies of their medications, inhalers, or oxygen. If patients become unstable, we see them acutely so that we can treat them earlier and they don't end up going to the emergency department or having to be admitted to the hospital.

Going forward, heat waves will be a major source of health instability. The Earth is warming, and heat waves are increasing in frequency, affecting people to a significant degree. Thousands of people died during a heat wave in Europe a few years ago, and several hundred people died in Chicago during a recent heat wave.

Medscape: ACP's climate change toolkit includes suggestions for "greening your practice." What practical strategies has your own practice implemented in response to climate change?

Dr Damle: I'm in private practice in an eight-physician group. We have about 20,000 square feet of space, and we have implemented some significant measures to reduce our carbon footprint. We installed energy-efficient lighting, heating, and air conditioning. We use recycled products and water fountains instead of water bottles.

A wind farm has recently been erected off the coast of Rhode Island. It supplies the power for our electrical grid. Two of our employees have electric cars, so we are putting in an electric charging station. Many real-world changes can be made, some small and some more significant. Collectively, they can make a huge difference.

Medscape: What is the potential economic impact of such measures to a physician practice?

Dr Damle: Most of these measures can be implemented at relatively low cost. There may not be an immediate return on investment, but setting the example for the community has value. Physicians are an important and respected part of the community, especially if they are in private practice in smaller communities. These steps provide an opportunity for physicians to talk about global climate change and health. They demonstrate that physicians have some "skin in the game" by putting into action the things they are talking about.

Medscape: Changes also are being made within your hospital system. How critical was advocacy on your part and that of other physicians in encouraging the hospital to make these changes? Or were the decisions mainly driven by economic considerations?

Dr Damle: Our local hospital system understood the consequences of climate change on human health and was willing to implement green energy design in building renovations and was energy efficient, using wind and solar energy. For some measures (food waste, recycled products), the hospital might even see an immediate return on investment. These mitigation strategies can have a substantial impact; and, by implementing them, the hospital becomes a role model demonstrating what the healthcare system can do to battle global climate change.

Medscape: Why did ACP create the toolkit? Will any of the items within the toolkit take clinicians by surprise?

Dr Damle: The toolkit has two functions. First, it consolidates all of the current information into one resource that is easily accessible, whether on a website or in printed form. Its purpose is to educate and encourage health professionals, in a simplified way, to take action. Second, the toolkit includes slide presentations that are available to any ACP diplomat who wishes to use them to educate students at schools, colleagues at local chapter meetings, and the general public. The toolkit can be downloaded, and the slide sets are available to ACP members.

Medscape: Downloading a slide set and educating others is a way of establishing physicians as leaders within the community. That has benefits for physicians in enhancing the presence of their practices, as well.

Dr Damle: Absolutely. There are benefits to this exposure as a community leader, as someone with authority and credibility to whom the community looks for guidance. Spreading the word will help to mitigate the influence of naysayers on the topic of global climate change. Climate change is real, it's here, and it's time to take action. If we don't, the health consequences and consequences to the Earth are going to be significant, not just in the next 100 years but in the next 10, 20, or 25 years.

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