We live in an increasingly ‘green’ world. If a man woke from a coma after thirty years, he’d honestly believe the Irish had taken over the world! Turn on the television, open the newspaper, log onto your favorite news site or walk down the aisles of any store and the word ‘green’ will all but assault you. Green homes, green cars, green industry, green hobbies, the concept is everywhere. So I thought, ‘as an emergency physician, how can I make the world greener?’

Let’s face it, hospitals are huge users of resources and power. We throw away papers and dressings, organs and needles. We burn waste, we use landfills, we aren’t very ‘environmentally friendly,’ shall we say. Mind you, we take care of humans, but the idea that humans are part of the environment is now a bit ‘old school.’ Apparently, from what I read, humans are not part of the problem…humans are the problem! Old planet earth is fairly infected with bipedal parasites of the Homo sapiens variety. Since we in the ED see so many of those critters, and use so much of the planet’s coveted resources to look after the pesky varmints (thereby keeping them alive), how can we make things better for planet earth?

Well, I can tell you, first and foremost we could just stop doing such a darn good job. If we let a bunch more humans slip through our fingers (after appropriate tort reform), the earth would be a lot less populous. Let’s face it, dying has a profound way of reducing one’s carbon footprint. We save lots of lives every day, and if we just didn’t, they wouldn’t be exhaling nasty carbon dioxide like they have for their entire selfish lives. There would be fewer cars driven, less fuel used, decreased need for that pesky, nature-destroying agriculture, less need to imprison, kill and eat animals, reduced industrial production and far fewer pharmaceutical chemicals poured into our ecosystems. So, maybe as a group on the forefront of the ‘human problem,’ we ought to just let some more deaths occur. Don’t we owe it to the earth? (For an example of the power of this technique, just go read about the reduction in humans accomplished by the DDT ban! Of course, most of them weren’t of Western European descent, so it’s really our turn now.)

Similarly, if we had less doctors and nurses coming to work, there would be fewer miles driven and less greenhouse gas production. (If fuel costs keep rising, that will be pretty easy to accomplish). Patients would wait longer and, obviously, bad outcomes would occur. But eventually people would settle down into a reasonable expectation that we just couldn’t save everyone, and they’d stop bothering hospitals for care. A little resignation, a little acceptance of the harsh realities of mortality, and you’re back to suggestion one, above. Less people! I’m confident that before modern health-care was available, people just lived with dying and were grateful for the few years they had. My grandmother lost a cherished baby brother to diphtheria, since there wasn’t much care back then in rural West Virginia. But hey, that’s just how it went, right? Less human animals due to death by natural causes; diseases are, after all, natural; despite the efforts we put into eradicating them. And the earth wasn’t ‘in the balance,’ back then, was it? Diphtheria did it’s work, I suppose, and made us all a little safer.

You might have detected a little sarcasm there. I read and enjoyed Jonathon Swift’s ‘A Modest Proposal,’ in high school. The parallels are not insignificant. What can I say? I’m impressionable. I believe that ultimately we ought to be very careful about the way we both impact, and manipulate, the environment. Because the environment is necessary for a species close to my heart; my family, friends and me! I’m a huge fan of survival.

But beyond sarcasm, there are some things we could do to make the world better Let’s bring it home to hospitals. How about reducing the amount of paper we use, and ultimately waste, by cutting back on unnecessary forms, documentation and oversight? How many gazillions of reams of paper go into every imaginable, and quite a few unimaginable, bits of paper that waft through hospitals every day? How many oversight and safety programs fill file-rooms with documentation of all sorts every day? When I just look at the smothering weight of paper used in filing and fighting with insurers, or the charting nurses have to do, I’m aghast. Forms for permission to treat, forms for promise to pay, forms for medical necessity of a procedure or drug, forms for restraints, sedation, commitments, blood, screening exams regarding nutrition, immunizations, abuse, language skills, drug and alcohol abuse. The list is exhaustive and exhausting. Hospitals, government and industry simply have too many people devising and overseeing too many forms on too many bits of paper. What if they’re all computerized, you ask? The computer doesn’t run on solar, does it?

So, let’s cut out great swaths of middle management in medicine and government. I submit that federal programs and Joint Commission contribute mightily to excessive fuel used by forcing people to fly to Washington to defend themselves or lobby for changes; by causing doctors and nurses to drive to constant meetings, and by decimating the world’s trees with a surfeit of forms. Don’t take my SUV! Stop the madness of rules, regulations and forms. (Oh, and make our representatives in Washington live in their homes states and work via the Internet. It would result in reduced travel costs, reduced fuel and accessibility for the occasional tar and feathering.)

Of course, if we radically change malpractice in America so that we don’t practice defensive medicine, we won’t have to fire up those X-ray machines, CT scanners or MRI’s all the time. And we’ll have fewer forms to fill out. We’ll be able to accomplish more and do less for the patient, and at the same time ‘green-up’ our hospitals and clinics to make the earth a happier place.

It gets harder. We could occasionally just tell people they aren’t sick, don’t have any of the many imaginary diseases modern man has concocted, and send them on their way without any extra chemicals or procedures needed. They’ll be unhappy, but if we don’t have all of those ‘patient satisfaction’ forms to fill out, then no one will have to worry about it.

And we could honestly tell them to stop doing some of the ridiculous things they do that bring them to hospitals in ambulances in the first place; like drinking to excess, using drugs, fighting, ‘cruising’ in cars all night, having inappropriate sex or lying around playing X-Box instead of holding jobs. I tried to figure out how reducing the ‘disability’ roles would help, but honestly, some of those people use and produce so little energy that it’s hard to see how they could damage the environment at all. I guess we could make them into artificial reefs!)

I know it’s a complex problem. But I think that there may be some room for improvement here. We in medicine, especially in emergency medicine, can give so much to improving the world if we just try. I mean, so far all we have done is use up resources while desperately trying to keep people alive and well. Who knew we were wrecking the world all along?

So get on board, my brothers and sisters! Let’s save the planet! And let’s turn those white lab-coats to green. And in the process, let’s streamline what we do. Maybe a little global warming is just the thing we needed to motivate us all along.

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