As the RCP launches its new sustainability and climate change campaign, our sustainability fellow Dr Toby Hillman reflects on ways we can deliver high-quality healthcare to populations today without compromising the ability of future populations to do the same.
As life returns to a semblance of normal after the COVID-19 pandemic, we have seen progress on many fronts in medicine.
There was a fallow period during the pandemic, where it seemed the rate of progress in medicine in many fields stalled, and all efforts turned to one subject.
Since emerging from the severely restrictive conditions of lockdown, clinicians have been working to reduce waiting lists, and assess more patients than ever. They are seeing the deleterious effects of two years of reduced contact with medical care in patients with long-term conditions, and later presentations of disease.
In the meantime, the rate of progress in academic medicine seems to be as fast as ever, and very few weeks go by without announcements of new drugs, more precise targeting of tumour types, and the prospect of truly personalised medicine coming ever closer in the mainstream.
Medical conferences have returned – with presentations on the latest data, new therapies, new devices and future directions for care in all spheres. The trade stands have been resurrected, and reps do their best to highlight the benefits of their company's approach or product over others.
The ability to attend a conference was one of the sorely missed aspects of professional life for many of us – an opportunity to catch up with friends and colleagues, share the latest news, see what passed you by in the journals, and glimpse what is coming over the horizon.
The mindset we adopt when attending events like these is usually hopeful, and forward-looking. After all, a key professional driver for physicians is the acquisition of greater knowledge, to better treat those patients we meet in the consulting room.
The Med23 conference this year, while ticking all of those boxes, has another angle which challenges this viewpoint. The central theme of healthcare sustainability – the aim of delivering high-quality healthcare to populations today without compromising the ability of future populations to do the same – prompts us to challenge some of the assumptions we have about progress in the medical world.
Medical progress is a double-edged sword when we consider it from a sustainability perspective. As interventions become more complex, precise and effective; the carbon footprint, resource use and waste can increase. Where a conversation in the past with a trusted physician could have reassured and supported a patient to effect a recovery over time; new knowledge and technology affords us an opportunity to investigate further and our trained focus on the individual blurs our understanding of the opportunity costs of such an approach.
I am in no way advocating a return to early 20th-century medicine, or that we should give up on the quest to understand and treat pathology to the best of our ability. But when held up to the background of inexorable global heating, population displacements due to extreme weather events, and spreading vector-borne diseases into new populations, it is the duty of physicians to protect not just the health of an individual that has reached them in a clinic, but to also pay heed to the needs of the patients they may not have met yet, potentially abroad, but increasingly likely to be from our own localities.
In a globalised world we must learn the lessons of history – as Ronald Wright highlights in his book, A short history of progress:
‘Many of the great ruins that grace the deserts and jungles of the earth are monuments to progress traps, the headstones of civilizations which fell victim to their own success.’
So, when you go to your next conference, whatever your aim, of course you should learn about the new opportunities available to make life better for the individuals you see, but please don't forget to challenge yourself too. Alongside your enthusiasm, pause to consider what opportunities there are for the greater good through tried-and-tested methods that also benefit society as a whole. What could smoking cessation, increased physical activity, active transport, increasingly plant-based diets do for your patient population? If we can get the basics right, perhaps our progress as a civilised world in the future won't end as it did for so many societies in the past.
