A GP, the environment and an article in the press
This morning, I broke the golden rule. I picked up my mobile phone and looked at my news feed, and I was surprised to find an article in The Telegraph by Michael Deacon titled "GPs Have No Right to Lecture Their Patients About Climate Change." Michael gives a fictitious example of a patient being lectured about the planet's state when the patient wishes to discuss their ingrowing toenail.
Upon initially reading the article, I felt irritated and frustrated. I wondered if the author, Michael, had a negative experience with GPs in the past and if this coloured his perspective. I don't know what the purpose of the article was; if it was to irritate GPs, then well done Micheal - you got me.
However, the final paragraph dismisses the entire issue by claiming that getting a GP appointment is impossible, perpetuating the ongoing negative narrative from the media.
The British Medical Association (BMA) reported that between June 2023 and May 2024, approximately 362.4 million standard appointments were booked, an increase of 68.4 million compared to the previous year. In May 2024 alone, 30.5 million appointments were delivered in general practice, averaging 1.45 million daily appointments. This is (in my view) impressive because the number of available GPs is decreasing. According to the BMA, in May 2024, there were 1,715 fewer fully qualified full-time GPs compared to September 2015. On average, each GP is now responsible for an extra 354 patients, an 18% increase since 2015.
Michael mentioned "green prescribing," and I thought presenting a different perspective for balance would be helpful. The Royal College of Physicians has published a green physician toolkit, which Michael referenced in his article. According to the Royal College, climate change poses a significant threat to health, leading to nearly 3,000 additional UK deaths during heatwaves, with some estimates indicating over 10,000 heat-related deaths per year in the coming decades. The toolkit outlines various actions physicians should consider incorporating into their daily practice. Notably, it emphasises the potential benefits of communicating with patients about the impact of climate change to help them understand how it will affect their health.
Instead of the unusual story shared by Michael, I believe it would be helpful to consider how a doctor could explain to an elderly patient the effects of taking multiple antihypertensive medications during extreme heat, such as when temperatures reach 30 or 40 degrees. It's important to discuss the potential risks, including low blood pressure, kidney problems, hospitalisation, and death.
On the other hand, many elderly people, due to financial difficulties, don't heat their homes adequately in winter. It's crucial to identify vulnerable individuals in our communities and ensure they have access to social support and other essential services. This helps them stay at home, reduces the load on our emergency departments, and could prevent hospitalisation or worse.
The toolkit discusses ways to limit the environmental impact of travel. More and more meetings are now held online, which reduces the need to drive to meetings and lowers our carbon footprint. 65% of general practice appointments were conducted face-to-face, according to the latest figures and remote consulting has reduced the need for patients to travel. While I don't advocate for mandatory telephone work, we should recognise the benefits of conducting patient reviews in this manner when it's appropriate.
Most of the contributions of health services' CO2 come from our use of inhalers and transportation. It's important to prioritise a more environmentally friendly approach when prescribing inhalers. According to the Royal College of Physicians Toolkit, the NHS accounts for about 40% of the UK's public sector emissions. As recommended by recent guidelines, transitioning patients to lower CO2-producing inhalers and consolidating them to a single inhaler could enhance medication compliance and concordance, benefiting both the environment and the patient. While there's ongoing debate about the use of dry powdered inhalers versus pressurised devices, physicians need to consider not only their but the treatments impact on climate change.
When encouraging patients to be more physically active and ditch their cars, we should consider the environmental benefits as well as the advice from the World Health Organisation. Regular physical activity offers significant physical and mental health benefits, such as preventing and managing cardiovascular disease, cancer, and diabetes, as well as reducing symptoms of depression and anxiety. It can also improve muscle strength and balance and prevent cognitive decline in the elderly. This potential for a healthier, more active population is a source of hope and motivation for both patients and healthcare professionals. Unfortunately, according to World Health Organisation data, a third of adults and 80% of adolescents do not meet recommended physical activity levels. As physicians, we are responsible for providing evidence-based advice, and promoting physical activity over car usage is a clear example of evidence-based medicine. Furthermore, addressing key public health challenges, such as non-communicable diseases like cardiovascular disease, hypertension, cancer, type 2 diabetes, and dementia, can be achieved by emphasising the benefits of physical activity.
The Health Foundation report in July 2023 highlighted that by 2040, an estimated 9.1 million people in England are expected to be living with a major illness. The report predicts a significant increase in conditions such as anxiety, depression, chronic pain, and diabetes, which are typically managed by GPs and other healthcare professionals in general practice. Another finding from a separate report revealed that during the winter of 2019 to 2020, there were approximately 28,300 excess winter deaths, with about a third of these attributed to living in cold homes. Additionally, it was found that children living in poorly heated homes are over twice as likely to suffer from conditions like asthma and bronchitis compared to those living in warmer, well-ventilated homes. Furthermore, poor air quality can lead to an increase in respiratory infections and the growth of damp and mould, exacerbating asthma in children and adults.
While I appreciate Michael's comments (except for the remark about access - it's outdated and untrue - it's not IMPOSSIBLE to get an appointment with a GP), I hope this presents a balanced alternative article. As a fellow professional, I'd like to invite Michael to visit my clinic and witness firsthand the benefits of discussing the environment with patients daily. This includes not only on a global scale but also locally addressing the importance of adopting healthier lifestyles for people in managing their chronic conditions. Of course, this offer would be contingent upon my patient's consent.
I don't have X so I haven't messaged him direct, but very happy for people to pass the link along.
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