The Climate Crisis and the Exam Room
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J Gen Intern Med DOI: 10.1007/s11606-020-06050-3 © Society of General Internal Medicine 2020
after our daughter was born, my family travT heeledsummer to my husband’s home of Puerto Rico. It was nearly two years after Hurricane Maria had devastated the island with unprecedented force and the impact was still visible throughout the island. One hot humid night in San Juan, we sat in my sister-in-law’s un-air-conditioned kitchen, monitoring a circling tropical storm and hoping we would make it back to the continental US before it struck land. All of a sudden, it struck me. The echoes of Hurricane Maria, the hotter than usual summer temperatures, and the early tropical storm all reminded me of one thing: our changing climate. My daughter would turn 31 in 2050, when recent data predicts that a quarter of the world’s cities will experience climate conditions not present anywhere on earth today.1 The questions started flying. Would my daughter feel safe on this planet? Would she be able to explore the world like I had? Had my husband and I been selfish in creating this small beautiful being? I admit I had taken a rather cavalier approach to the climate crisis throughout much of my life. I had spent 10 years of my youth becoming a doctor and I had somehow managed to frame climate change as a threat to the polar bears and the ice caps, but not to my patients or my family. Throughout my medical training, no one had had forced me to see the profound connection between a changing climate and my new profession. As helplessness set in, my motherly instincts began to shift from how to protect my daughter against sunburns and viruses, to how to protect a healthy future for her on this planet. At home, healthy choices took on new meaning—compost over trash, electric vehicles over student loans, chicken over beef. When my maternity leave ended, I started my first attending position at a county hospital. While I had once used my profession as an excuse for inaction, I started to wonder what the role of a doctor should be in addressing this crisis, and why
Received February 5, 2020 Accepted July 10, 2020
we aren’t talking about it more—both amongst ourselves and with our patients. WHO estimates that between the years 2030 and 2050, 250,000 annual deaths will be attributed to climate change.2 Rising temperatures will cause heat-related illness and death and lead to disruptions in food supply causing malnutrition. Air pollution will influence the incidence and severity of diseases like asthma, COPD, heart disease, and cancer. And survivors of natural disasters will experience sometimes ongoing and recurrent trauma.3 Doctors are increasingly concerned about climate change and have proposed important roles in disease surveillance, policy advocacy, and healthcare reform. Yet, physicians’ voices are powerful not only in op-eds, research, and advocacy, but in the quiet trusted spaces of our exam rooms. What if we started to talk about climate change in our daily visits with patients? What kind of a vehicle do you drive? How do you heat yo
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