Abstract
First of all, I have to declare that I have been a four-season bicycle commuter for over 30 years, even while maintaining a busy surgical practice and operating at as many as 4 different hospitals. I have also been recycling every possible recyclable item in my personal life for 44 years. I am a member of Doctors for Planetary Health—West Coast 1 and for World Health Day 2022 took the Planetary Health Pledge. 2
The conclusion that hand surgery can “pave the way for other specialties” and that hand surgeons can “act as role models” in the movement to carbon-neutral hand surgery is timely and inspiring. 3 This fits with the WHO, 4 and the IPCC 5 goals for mitigation of the current climate crisis and the CMA's net-zero health care goal as part of their “Impact 2040 strategy.” 6
As surgeons, we are part of the problem. We have a responsibility to the earth to reduce our 20% to 70% contribution to hospital waste. While the care of individual patients is obviously important to surgeons the authors also point out the public health importance of climate change and indeed, we are in a climate health emergency. The rate of death in the summer heatwave in BC was higher than for either of the 2 officially declared public health emergencies (the opioid crisis and COVID-19). 7 Our operating rooms are places where the authors demonstrate that we can make a difference.
The paper offers a 5 R's framework to consider: Reduce—only open what you need when you need it, Reuse—single-use devices can be reprocessed (sorry manufacturers, it's time to get on the green train), Recycle—clearly separate clean and contaminated items and ensure that all items that can be recycled are recycled, Research—document the impact of making these types of chances and publish, collaborate on the development of “green” devices and Rethink—develop greener systems of patient care, travel accounts for about 50% of GHG emissions. The references cited demonstrate isolated examples of activities and changes to practice that can save money and reduce waste. These ideas need to be scaled into every operating room. Finally, I would add an additional “R,” “Refuse.” As surgeons, we should not just accept what we are given. We are in a position to collectively change the system.
Finally, the authors rightly represent the need for a shift in culture. The climate health emergency is everyone's responsibility. There are many small and large initiatives that can be tackled in your operating room with the help of your colleagues and your organization. This will involve collaboration with all of the systems and people who support operative care. In health care, we should be part of the solution, not part of the problem. Start a Planetary Heath Group at your hospital. 8 Teach and present on this topic 9 Primum non nocere.