UK doctors advised to cut down on prescriptions and blood tests to tackle climate change

Doctors should reduce “unnecessary” prescriptions and blood tests in a bid to curb their profession’s contribution to the climate crisis. That’s according to new guidance released by the UK’s Royal College of Physicians (RCP) this week. 

Its ‘Green Physician Toolkit’ suggests a range of actions that doctors can take, including talking to patients about how to protect themselves from the deadly impacts of rising emissions.

“It can of course be challenging to prioritise sustainability at a time when there is very high demand for clinical care, but we have to keep in mind that reducing climate change and its health impacts is part of reduced pressure on the NHS in the long-term,” says Professor Ramesh Arasaradnam, RCP academic vice president.

The National Health Service produces around 40 per cent of the UK’s public sector emissions and four per cent of the country’s total emissions. In 2022, it became the world’s first health system to set a net zero target of 2040.

But other European countries are looking to limit their healthcare pollution too, and this isn’t the first time that prescriptions have come under pressure.

Last year, the Standing Committee of European Doctors (CPME) said that “unnecessary pharmaceutical use should be reduced and the aspects of higher compliance must be considered as many drugs are prescribed but not taken and thrown away”.

What steps can doctors take to reduce waste and emissions?

To stop over prescribing, the RCP’s toolkit recommends using “shared decision-making approaches” with patients to reduce the environmental burden of medications that are no longer useful. Or to consider other options before a medicine is prescribed in the first place. 

Doctors have access to digital systems for support with deprescribing. And with 20 per cent of NHS carbon emissions coming from medicines and chemicals, reducing prescriptions where they’re not needed will make a significant difference.

The CPME paper noted too that many pharmaceuticals consumed in Europe are manufactured outside of the continent. “Closer production would reduce the carbon footprint and support the possibilities to monitor the climate impact of production processes,” it said.

The Green Physician Toolkit identifies numerous other areas where environmental and climate costs could be dialled down. 

Generating less waste is a big one; patients should be encouraged not to flush pills down the toilet (thereby contaminating water supplies) it says, and instead return old or unwanted medicines to pharmacies where they can be safely disposed of.

As for diagnostic activities like blood tests, doctors are advised to think twice before making a blood test request - or to see if multiple tests can be run from the same sample. Previous research has shown that blood tests produce between 49-116g CO2 equivalent each, including the emissions associated with producing, transporting, processing and disposing of the equipment and its packaging.

How can doctors talk to people about climate change?

As the toolkit acknowledges, doctors are uniquely placed as trusted members of the community to discuss public health threats with us.

The World Health Organization has some communication tips for professionals to bear in mind  - and some are useful for anyone embarking on tricky climate conversations. Keep your message simple, WHO advises, talk about climate change during extreme weather events and highlight the health benefits of climate action.

As one example of a conversation starter, the toolkit has: “Climate change means heatwaves are becoming more frequent. Here’s how heat can affect your health, or how your medication can make you more vulnerable to heat.”

 Another goes: “When cars burn petrol, they emit toxic air pollutants that can be bad for your health. Remember to carry an inhaler, avoid busy roads where possible and consider wearing a mask outside.”

Doctors should identify their most at-risk patients, according to the RCP, including those with long-term health conditions, the frail and elderly, young children and pregnant women. “Be alert to the mental health impacts of climate change, including eco-distress and depression/anxiety/PTSD related to flooding,” it adds.

What do doctors think of the new guidelines?

“The changing climate is directly impacting our minds, brains and bodies. It’s not just around us but within us, as doctors our role is to support patients to learn and understand how this will impact their individual health and our collective public health,” a Health for XR (Extinction Rebellion) campaigner tells Euronews Green.

“We need to create environments for patients that allow any questions to be asked and explored, with us bringing the most up to date medical knowledge to them regarding climate impacts, to ensure we uphold public trust.”

The toolkit also celebrates positive examples of physicians making sustainable changes - such as reducing short-acting beta agonist (SABA) inhalers. The majority of these are pressurised with greenhouse gases, so their overuse is bad news for the environment. 

By switching patients to a maintenance and reliever therapy (MART) asthma treatment, one NHS project has removed nearly 75,000kg of CO2 emissions from the environment, equivalent to 37.5 return flights from London to New York.