Compatriots!

Article by Thomas Robey

I have to admit: my complexion has adopted a green hue after living in the Emerald City (Seattle) for 6 years. I’m not referring to gardening skill, increased nausea, or skin mildew, nor am I a Ralph Nader supporter. The green in me is due to being bitten by the environmentalism bug. I didn’t realize how bad it was until I found myself in a country where my habits clashed with everyone else’s. For example, when returning from a clinical rotation in Eastern Washington, I hauled eight bags of aluminum, plastic and paper home because it was not apparent that those items could or would be recycled in Spokane. Yes, I know this qualifies me as over the deep end. Your follow-up thought is “what has this to do with a medical blog?”

The differences in recycling between cities can be played out on a much smaller scale. Do your school or workplace recycling habits resemble your behavior at home? More and more of us know by heart the recycling rules in the kitchen: “#5 plastic is okay, but the lid goes in the trash,” or “save that deli container for my next art project.” Does this behavior get checked at the clinic door? Does your medical center recycle? If so, I bet that all attempts to reduce waste go by the wayside in the hospital’s operating room. There’s good reason for OR’s to make extra waste (namely, sterility!), but it’s hard to believe that all of that stuff needs to be disposable!

Change is always hard – how many of your patients quit smoking with their first try? As with other behavior modification, improvement is easiest on a small scale. Here are some small examples of correctable material waste that I’ve noticed in health care:

* recyclable cardboard glove boxes in the trash

* single use metal suture kits (forceps, scissors, needle drivers)

* no beverage container recycling

* disposable sterile or contact precaution gowns

* no white paper recycling

* only styrofoam plates and plastic utensils are available in the cafeteria

* shredded patient information sent to the regular waste stream

* plastic water bottles at every conference

And these are just the obvious ones. I hope you could hear the incredulous tone of voice as I listed these off! What waste do you see where you are learning/doing medicine?

International readers might wonder why hospitals allow steel instrument sets to be thrown away. The answer is expense. It costs more to collect, clean, package and sterilize the instruments than to buy lower quality ‘one-use’ tools. Even these cheap instruments last a while - I salvaged and sterilized one of the sets I used in an ER and practiced suturing at home before discovering how helpful they were for projects around the house requiring fine manipulations.

Presenting ideas to a large institution or making suggestions as the new guy who’s just here for 6 weeks is intimidating. But there are a number of little solutions to reduce waste that you can do as a student (i.e. as the lowest rung on the ladder). The surgeons in one red state thought I was a nut for putting out a box to collect aluminum, but a week later it was full. I take home papers without patient information on them for the bin. Even just inquiring about a clinic’s recycling policy could result in a system change.

As fuel and plastic prices increase and more people become aware of resource limitations, it will become more important to reduce, reuse and recycle, not just to save the planet, but to reduce the bottom line. And it may just be those energetic new students or house staff who help translate ideas into actions. What will you do?

Comments

Great Blog, I find it hard to believe that so many physicians don't care at all about the environment. You're right to make the point about how much money they could be saving by re-using and reducing their waste. Another great point is that environmental degradation has serious health implications like allergies, asthmas and increasing cancers. As a physician who cares about a patient's health, it just makes sense to care about the environment they are living in as well.

Posted by: Christine | May 28, 2008 11:05:29 AM

Very interesting post. As for paper which contains private data, there are vendors who perform secure recycling services. We use them at our bank, and it is the same process for our note-taking during support calls as it is for destroying other sensitive bank records and even checks. The disposal services offer locked bins for us to drop the paper in, then they pick them up and pulp the paper without any human eyes seeing the contents. It's far more secure than shredding documents.

I can understand why surgical instruments are single use on patients, but I have always wondered why they can't be sterilized and used for medical school work on cadavers. It would save the medical schools a great deal of money.

Posted by: Mike Haubrich, FCD | May 29, 2008 4:36:40 AM

T-
Good for you for being a recycler- I am too. Shame on you for not taking the extra five minutes online the Spokane Review's website or other Eastern Washington Counties webpages to discover that there are recycling drop off centers located in and around Spokane. I have lived in Spokane off and on for several years when staying with family as I have posted before. My most recent stint there corresponded with yours when I was studying for the boards - and while I found that the ease of recycling at the end of your driveway wasn't there. I did still find plenty of ways to have my plastics/can/paper into a recycling bin.

Posted by: Irene | May 29, 2008 6:06:26 PM

also - to follow up. AMSA did an indepth article regarding the issue of waste/recycling in the medical industry in its April 2008 issue. I belive it is available online or you can order print copies of the magazine. www.amsa.com

Posted by: Irene | May 29, 2008 6:09:18 PM

Beverage container recycling? You mean using non-disposable and just washing them, right?

P.S. Elegant usage of recycled electrons ;)

Posted by: Jared | May 30, 2008 4:01:27 AM

Just a few responses:

Irene: I did find places in Spokane to recycle some items. The drop-offs were open 8A to 8P, charged a fee for glass and mixed paper, paid out for aluminum and would not accept some plastics. My medicine and surgery hours plus call schedules made the special trips to the drop-off centers difficult.

Jared: You are right that reusing coffee mugs etc., is better even than recycling. What I was referring to was the glass, plastic and aluminum bottles and cans that soda, water and energy drinks come in. I have been challenged before on the carbon neutrality of blogging, but have not figured out quite how to measure it ; )

Another wrench in the sustainable OR movement is liability. If every patient gets a new (disposable) sterile drape instead of a laundered and sterilized cloth cover, I bet the hospital is better protected against infection liability. A quick search netted no AMSA article. I did find that one of AMSA's issues is open access. Perhaps that does not include 'convenient access.'

Posted by: thomas robey | May 30, 2008 3:16:50 PM

Great post! I admire your thinking so much about the environment and taking pains to ensure recycling your waste... I attended medical school in India and as a visiting student at a big university hospital in US, I noticed the huge amount of waste that such a big hospital generates.... quite a lot of which can potentially be avoided.... I think minimising paper-based patient notes and switching off lights and computers when not in use should be a good start.

Posted by: Anuja | Jun 3, 2008 9:59:30 PM

Good post. I live in England and work at the a major psychiatric research centre. I was appalled when I started work there and found out how little recycling went on. I was also shocked by how little sense of social responsibility many of the scientists/psychiatrists had. It seemed that this was also inversely related to peoples pay packets. We have however, managed to get a recycling scheme in place and are in the process of challenging our throw away culture. Next campaign may be to stop departments from getting drinking water shipped in by truck (which has to be the about the most obscene of all our excesses). It's hard, but worthwhile.

As for surgical equipment, it would be interesting to revisit sterility. I wonder how much of this argument is really just an excuse to take the easy option and throw away. Does it really cost more to sterilize that to throw away, or is this just myth?

Posted by: Fergus | Jun 8, 2008 4:09:54 AM

I really enjoyed reading your post - you're quite the trooper to take on this shared responsibility! I also understand the delicate nature of not rocking the boat when you're the new kid on the block. Is there a discreet (or anonymous) way to send a signal that greater recycling is needed at Eastern Washington?

My colleague and I recently published a paper that showed a 34% increase in recycling simply by using specialized recycling lids. I wonder if there was a way for you to sneak this paper onto someone's desk? Maybe it could motivate the janitorial staff to adopt systematic recycling practices (as opposed to you doing all the work).


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http://mypage.iusb.edu/~mverges/Duffy&Verges_inpress.pdf

Posted by: Michelle | Jun 9, 2008 2:58:40 PM

This is a great article. This aritcle brings about a couple of important American cultural ideas; convenience and ignorance (advertent and inadvertent). These ideas do not always persist in other countries. As the population of the earth rises, what price is going to paid for using "one-time use" convenience items? Stepping out of the physician personality to examine the world in different shoes is important. It is critical that we 'self-examine' ourselves and do it honestly. Even though I am studying to be a surgeon, I am still a biologist in love with out-of-doors, not just human biology.

I think a critical link for not only physicians, but other people, is to understand that environment controls health! Researchers spend a lot of time and money trying to find links in human health and the environment.

If physicians cared more about the environment, do you think others (non-physicians) might follow?

Posted by: Amanda | Jun 9, 2008 3:17:24 PM