Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
(RW) Climate Health II: Gregg Furie
19 Plays9 days ago
(REWIND) Season 3, Episode 3: Dr. Gregg Furie is an internal medicine physician and medical director for climate and sustainability at Brigham and Women's Hospital in Boston, MA. Listen to Gregg discuss the effects of climate change on our health, ongoing policy initiatives to reduce healthcare emissions and his approach to addressing climate change with patients.
Recommended
Transcript
Introduction to 'The Wound Dresser' and Dr. Greg Fury
00:00:09
Speaker
You're listening to The Wound Dresser, a podcast that uncovers the human side of healthcare. I'm your host, John Neary.
00:00:21
Speaker
My guest today is Dr. Greg Fury. Dr. Fury is an internal medicine physician at Brigham and Women's Hospital in Boston, Massachusetts. Dr. Fury is also the medical director of climate and sustainability at BWH.
00:00:34
Speaker
In this role, he works to prepare clinicians for health threats due to climate change, reduce the environmental impact of hospital operations, and advocate for policy changes that address climate change.
00:00:45
Speaker
Dr. Greg Fury, welcome to The Wound Dresser. Thank you for having me. pleasure to be here.
Impact of Climate Change on Health
00:00:52
Speaker
So just to start big picture, can you talk about ah what are the main environmental changes affecting our planet due to climate change and and how downstream they're affecting our health?
00:01:03
Speaker
So they're actually, so they're quite broad. um And i think a useful way to think about it is there are both environmental um exposures that are changing in the face of climate change that have a variety of different health impacts. um And those health impacts can be very direct or indirect. So a useful kind of example would be, particularly it's very topical at the moment, extreme heat.
00:01:32
Speaker
um So we know that with <unk> with ah kind of ah increasing global temperatures that we're having more and more of these extreme heat events and Those extreme and heat events can have very direct impacts on human health. So um Anything from like this spectrum of what we call heat related illness like heat stroke heat stress um But really the greatest burden is related to cardiovascular and respiratory impacts um
00:02:04
Speaker
aren't necessarily captured by those more specific conditions. So those are very direct impacts of extreme heat on human health. But then at the other end of the spectrum are kind of the more indirect um types of um impacts. And so an example of that would be changes in vector-borne diseases as a result of climate change's impacts on the ecology of natural systems that make kind of the environment...
00:02:35
Speaker
um capable of supporting different insect vectors of disease. Um, and as that changes over time, then the people who are exposed to those diseases is also changing.
00:02:49
Speaker
And then kind of like a very, like the very far end of that spectrum would be things like, um, mass migration as a consequence of kind of more kind of, I would say, extended changes in the environment as a result of climate change. So, for example, you have areas that are experiencing um year after year higher incidence of drought as a consequence of global climate change, then people may be forced to move from those places to other locations and we know that just that kind of um forced migration is in of itself associated with a variety of adverse health impacts, both anything from kind of like mental health to um physical health um that result from being in that kind of ah very kind of transitional
00:03:40
Speaker
ah um experience of of being forced to move. So so again, the the The impacts are broad. They affect essentially every organ system in the body, and they can occur in very kind of direct ways or um or very indirect ways.
Behavioral Changes Due to Climate Concerns
00:03:59
Speaker
As a ah clinician, when you're thinking about those direct ways climate change is affecting our health, are there, you know, patients you see in clinic who you kind of say to yourself, ah wow, you know, this this patient might not be having this problem if, you know, climate change wasn't happening?
00:04:15
Speaker
Yeah, and I think that's true across that entire spectrum. so um We see patients who, like I have older patients who now kind of won't leave their homes as frequently because they're concerned about the impact of extreme heat. So they're kind of increasingly socially isolated, but also, you know, they're not experiencing the extreme, like the the kind of adverse effects of extreme heat, but um they're changing their behavior in response to the the possibility of that. Yeah.
00:04:48
Speaker
I've made kind of diagnoses of Lyme disease earlier than I ever have in the past. Like, so in March in New England, that's pretty early to be seeing Lyme disease.
00:04:59
Speaker
um And then on my own patient panel, like i'm I'm a primary care doctor, and so on my own panel, I have I have patients who are kind of climate refugees. They are from Puerto Rico. i have one patient who had, he was, he has NCA adrenal disease. He's on dialysis and after hurricane Maria, um, or sorry,
00:05:22
Speaker
I forget exactly which hurricane it But after one of the like the major hurricanes in in Puerto Rico, when they lost power across the island, he couldn't get dialysis. And so he moved to the United States as a consequence of that. And I have other patients who also have moved from Puerto Rico in the wake of some of the disruption caused by hurricanes there. So...
00:05:43
Speaker
We're definitely kind of seeing all of these things in practice. um I think the challenge for us is to really understand how climate change is affecting the epidemiology of disease, really. so there aren't that many kind of new diseases that are coming up as a consequence of climate change. What we're seeing is that there populations that previously weren't experiencing different types of environmental exposures that now are experiencing them, um or because of the increased severity of those exposures, um people are having kind of a greater burden of disease as a consequence of that. And so I think as clinicians, largely what we need to be understanding is how is this epidemiology of disease changing?
00:06:31
Speaker
How are the patients that I care for being kind of impacted in new ways And how do I then need to think about not only um that risk um from a diagnostic standpoint, so I'm like making sure that I guess I should be thinking about Lyme disease in March when I normally wouldn't have or previously wouldn't have, um but also kind of from a counseling perspective. So helping our patients understand like what are the new risks that they are kind of experiencing and how do they need to prepare for that.
00:07:01
Speaker
So want to zone in on like, like hospital systems, for instance, for a second, I've heard you talk about emissions associated
Hospital Emissions and Sustainability
00:07:09
Speaker
with hospital systems. um What are the the term I've heard you use is like scopes of emissions. Can you talk about like the three scopes of emissions in hospital systems?
00:07:19
Speaker
Yeah, so and it's not just unique to hot hospital systems. This is a kind of well-accepted way of kind of categorizing the different types of emissions from any sort of um from any sort of industry or organization or even kind of your own like personal neural kind of like individual kind of impact on the environment. But so scope one, so it's basically divided into three groups, scope one, scope two, and scope three.
00:07:51
Speaker
Scope one, those are emissions that are attributable to um to on-site fossil fuel combustion. So you're actually, you as an organization are are directly contributing emissions into the atmosphere. It doesn't have to just be CO2. It can be any other gas that kind of contributes to the to the greenhouse effect.
00:08:16
Speaker
um But so that could be things like burning natural gas at your facility for heat and power. It could be, um your like the diesel or gasoline that you use in your vehicle fleet. So you're responsible for actually kind of like combusting that material and contributing the emissions into the atmosphere.
00:08:38
Speaker
In medicine, there are a few kind of like unique scope one ah um greenhouse gases and largely those are anesthetic gases, um which are very potent greenhouse gases. They have hundreds to thousands times the global warming potential of CO2.
00:08:57
Speaker
um And then there's some other gases that are commonly used in um in modern medicine that are very potent greenhouse gases. SF6 is another example. um So that's scope one. Scope two is ah are essentially emissions that are attributed to energy that you that you purchase. um So the the the the most kind of substantial kind of contributor there is just electricity, right? So you're buying electricity from the utility somewhere else. There is a um a plant that is either yeah is that may be using fossil fuels to essentially produce that of electricity.
00:09:34
Speaker
So those are your kind of scope to emissions associated with purchased energy. The other kind of purchased energy that is common for big um health systems would be um steam.
00:09:47
Speaker
So we kind of buy steam both as to heat our facilities but also um for things like sterilization. So that would be also also fall into kind of like scope two. And then scope three is kind of everything else. And it's largely made up by kind of our supply chain. So all of the emissions that are associated with the kind of manufacturing distribution and disposal of all the supplies and kind of other materials that are used in modern medicine.
00:10:18
Speaker
um So, and then that includes not only just kind of the kind of supplies that are being used directly in patient care, but also all the desks that you buy and the computers that you purchase and all of the kind of construction that's done um to either kind of build new buildings or renovate old buildings.
00:10:39
Speaker
And then there's some other things that fall into those categories as well. um Big ones would be kind of the actual energy associated with the disposal of your waste. um Transportation, both for ah for employees, um both just commuting to and from work, but also business travel.
00:10:57
Speaker
um All those things kind of fall into scope three. So yeah, scope one seems like it's kind of like more under the control of the hospital system compared to the the other scopes. So as a, like a climate health specialist, how how much do you feel like of your time and effort is allocated to, you know, reducing emissions and what's going on in inside the hospital walls versus like trying to do either greater advocacy work or, or you know, a greater work with your supply chain, like outside the hospital walls to lower emissions? Yeah.
00:11:29
Speaker
Yeah, it's a great question. um So first, I think it's helpful to understand kind of like what the relative proportion of the contribution it come is from each of those scopes, because it influences to some extent, how much time and energy we we place on each of them. But first of all, I completely agree that scope one and scope two are far more under the direct control of a health system or a hospital um because they can choose what energy source they use to some extent. um
00:12:04
Speaker
But those emissions from scope one and two combined typically represent maybe like at most 20% of a health system's total emissions. carbon footprint. And it depends a little bit on kind of what type of hospital you're talking about and whether you're talking about a hospital or an outpatient clinic.
00:12:21
Speaker
um it That influences the contribution to some extent. um But you can think of kind of like maybe 20% as a good ah general kind of like approximation of the contribution from scope one and scope two for kind of healthcare delivery.
00:12:38
Speaker
um And, and so I'm fortunate I work at a health system that has like a really kind of robust team that's focused specifically on energy use and energy pure procurement.
00:12:52
Speaker
And so they spend all their time thinking about this. um And for scope one, they're, they're,
00:13:04
Speaker
the The challenge is that like many health systems now rely on natural gas for heating and for steam production. um And there aren't great alternatives out there at the moment. um It's hard to, and although there are like hospitals that are beginning to do this, kind of go all electric, but it depends lot on kind of what part of the country are in, whether how feasible that is and how expensive it is. um And so...
00:13:33
Speaker
So there aren't great options for kind of like getting away from natural gas quite at the moment. um Sorry to interrupt. Could you just clarify like what you mean when you say all electric? um Because I feel like... Oh, sorry. Yeah. so So some health systems or like... So it's it's felt that because electricity can be generated using kind of like renewable sources of energy that if you kind of rely...
00:14:00
Speaker
solely on electricity for heating, powering and cooling your facilities, then there's the opportunity to really reduce your emissions associated with kind of that energy. um so um So many hospitals are beginning to use things like electric boilers to produce to produce energy or kind of like electric electrically powered um heat pumps essentially.
00:14:28
Speaker
So there's a way to kind of like rely on electricity to provide all those energy needs. But again, for hospitals, particularly hospitals that already are built, kind of like um retrofitting them to go all to be kind of dependent only on electric like electric sources of energy is pretty complicated um at this point in time.
00:14:53
Speaker
But that's it's an important goal and one that I think health systems and the healthcare sector are really going to need to begin to address, as are all sectors, um in order to find a way to address our scope one and two emissions.
00:15:07
Speaker
Um, so yeah, then then thinking about like the scope three, especially when you're thinking like, you know, outside the hospital walls, how much of your work do you feel like really depends on on policy and like, like like health, ah like policymakers at the state or federal level?
00:15:25
Speaker
Yeah, that's a great question. um i mean, ah first of all, as we think about scope three, a useful way to think about it is the same way we think about kind of sustainability more broadly, right? And kind of the whole idea of reduce, reuse, recycle. um So there's so much waste in healthcare, right? And so if we could just eliminate all of that, and and I'm not talking about kind of waste like trash, although there's plenty of that. I mean,
00:15:54
Speaker
things that we do within kind of like healthcare delivery that have minimal benefit for patients, um, they are expensive and they're necessarily, and they're associated with environmental harm as well.
00:16:08
Speaker
If we were really, if we could really address all of those things and just stop doing things that are, are not a benefit to patients and are in fact sometimes harmful to patients, um, we'd know that we we would be able to really reduce um some of healthcare's environmental impact. That largely comes from like scope three, because remember I said that scope three probably represents 80% of our total footprint. So um if we can eliminate all this kind of like low value and unnecessary care, then there's the opportunity to really have an impact on um our environmental impact um on on our total emissions.
00:16:46
Speaker
So, So that's just that's kind of like the reduced side. And I would put into that category just kind of a focus i like a stronger focus on disease prevention, right? Like we can keep people healthy and out of the hospital and not like requiring all these kind of intensive healthcare resources, then that too just helps reduce the environmental impact of healthcare delivery.
00:17:11
Speaker
um But so far, I think our country has not kind of taken that approach. we're not We're not particularly focused on prevention and keeping people healthy from a policy standpoint. Um, but I think it's somewhere we need to go for a number of reasons.
Healthcare Waste Management and Policy
00:17:24
Speaker
Um, so that's kind of like the reduce, um, the reuse side, like there, are there are kind of like many opportunities in healthcare to we've, what we've seen is this kind of steady progression towards more and more use of single use disposable devices as opposed to kind of reusable devices.
00:17:45
Speaker
Um, A lot of that has been done in the name of infection prevention. um I think the it's a little unclear whether kind of all of the kind of this transition that we've seen towards single-use devices can truly be justified based on that argument. um It's certainly kind of a convenient one because who is going to argue against trying to like prevent hospital acquired infections, but it's not 100% clear that the data supports um that this transition is actually having the like desired benefit or impact.
00:18:24
Speaker
And at some point, if we acknowledge that the there are actual true kind of health harms associated with our environmental impact, once you get kind of towards diminishing returns and in terms of each successive kind of transition to a single-use device, at some point the health harms from the environmental impact of producing and disposing all those devices begins to outweigh the kind of reduction in infections. And
00:18:55
Speaker
and so it's challenging for health systems because those impacts are felt kind of at the population level, not directly by the like patients in front of you. And also it's like an externality, right? So health systems aren't currently held accountable for the environmental impacts of their operations that affect populations across the globe.
00:19:16
Speaker
Whereas they are held accountable financially for kind of adverse events that happen directly to the patients that they're caring for. so... but so All this is to say is that there are many ways in which we could be kind of reusing things more effectively and moving away from this kind of ah kind of just what is becoming an increasingly frequent adoption of single use disposable devices as opposed to what we've done traditionally, which is to reuse a lot of things. um
00:19:47
Speaker
So there's a lot of opportunity there. um And then there's kind of like the recycle, which is really like, how are we managing our waste? um And you know we we don't do a great job of that. But I think the The big picture point is that we need to start by thinking about just kind of like conservation and just reducing the amount of kind of stuff that we use unnecessarily in healthcare.
00:20:11
Speaker
And that's not just kind of the products, but the services as well. Everything that we do and in healthcare that's not directly benefiting benefiting patients is just waste, right? And it's a waste financially, it's a waste environmentally, and it's potentially kind of harming not only the patients in front of us, but like everyone, the population more broadly. So from, to get back to your specific question, from a policy standpoint, I think they're kind of like very kind of healthcare specific policies that we need to kind of help, um, address scope three emissions.
00:20:46
Speaker
But more broadly, we need policies that are helping everybody address their scope one and two emissions. So, um, uh, our scope three emissions are somebody else's scope one and two emissions. So if we can help kind of the entire economy transition to more renewable um and sustainable sources of energy and kind of material consumption, um then we kind of are helping every industry reduce their own environmental impact. And I think that's what's required at the policy level to really kind of create the environment that drives people towards more
00:21:26
Speaker
um renewable use of renewable energy that's a source for kind of their operations, whatever kind of component of the overall health sector and the economy more broadly you exist in.
00:21:39
Speaker
So it sounds like there's a lot of low hanging fruit within our our systems in terms of the reduce, reuse, recycle. ah like that that's Those are things that can kind of be done at an organizational level that don't necessarily need like legislation to kind of move those things along.
00:21:55
Speaker
But are there any like pieces of of legislation that um like specific pieces of legislation you really wanted to see move forward at like the the Massachusetts state level or the federal level that would really move forward your work?
00:22:07
Speaker
um So like ah an example at the state level is, so within ah at within this within our local level, so within the city of Boston, we have a program called Birdo. um And basically it's an ordinance that requires owners of buildings that are over a certain size to um measure and publicly report on their emissions on an annual basis.
00:22:36
Speaker
And over time, they're going to be required to achieve certain emissions reductions. And if they don't achieve them, face financial penalties. um And that's a pretty powerful incentive to begin reducing emissions. So we're already seeing that happen in Boston at the state level.
00:22:56
Speaker
there's a new kind of climate, there's new climate legislation that is essentially going to be doing something similar. um And again, i think it's really going to drive change. So those types of programs that are kind of holding people accountable for reducing their emissions over time are can be very effective in and changing behavior and um driving this transition to ah greener kind of energy economy. So i do think they're there are opportunities for that type of legislation to be really effective.
00:23:30
Speaker
We haven't really seen something like that at the federal level. Um, I think they've been trying to use more of a like carrot than a stick approach. And that's what we've seen with the IRA, um which has been quite successful, right. And we are taking advantage of some of those IRA programs that are offering really kind of substantial tax incentives to implement, um,
00:23:54
Speaker
energy efficiency and, um renewable energy infrastructure projects within our own facilities. So, um, and then those are kind of like the, the main pieces of legislation that I think we've been seeing recently.
00:24:10
Speaker
um I think there are others that would be of interest, but we haven't, but I don't think I'm not aware of kind of specific legislation right now that were, that's being proposed. There is one, there is, there is, um,
00:24:24
Speaker
There is one piece of legislation that's been kind of led by actually one of the met one of the Massachusetts senators, Ed Markey, and I forget who ah who the other kind of co-sponsors of it are, which is really focused on addressing some of these other sustainability challenges within um within healthcare, care um focusing not only on the sustainability piece, but also on how are we ensuring that our health systems and And health professionals are prepared to address current and emerging threats from from climate change.
00:24:59
Speaker
So there are examples out there, but I think there are many way places in which kind of some increased focus on policy would help the health sector make this transition. ah you've You've mentioned some obstacles, right, to to getting a lot like moving a lot of these ah climate interventions forward. And one of them was ah infection prevention, right, that we use a lot of single use um ah plastics or single use devices for infection prevention purposes.
00:25:26
Speaker
And I think I've heard you talk about like. at the end of the day, like the way you can kind of move these climate interventions forward is you have to pose it as a win-win, right? That you're going not only have less emissions, but also better health outcomes and better, ah you know, hospital finances or an economic situation for the hospital. So can you talk more about how you kind of pitch that ah to administration and so forth at at hospital systems to say, like, not only are we going to reduce emissions, but we're going to improve health outcomes and help the bottom line?
00:25:57
Speaker
Yeah, so i think, well, first of all, for health systems, I think this is also largely a moral issue, right? Because contributing to death and disease through the environmental impacts of our operations is directly at odds with our overall kind of mission and values, right? our We're in the business of promoting health and well-being. And if we're kind of, if we're having adverse effects on the environment that are that are making people sick, then we are being inconsistent with our overall goals. um
00:26:29
Speaker
So I think that's an important way to first approach us. But it's true that many there are many ways in which sustainability efforts can help a health system um in a number of ways. One is financially. And it's there. are So many of these, so I work at a relatively progressive health system that has been doing work around energy conservation and purchasing renewable energy for a long time.
00:26:56
Speaker
When those efforts first started, it was not about kind of reducing our environmental impact or because it aligned with our kind of our values. It was about money. um And so many of these, there are many ways in which health systems can really reduce their costs by investing in um energy conservation and purchasing renewable energy. so um So there's some real kind of like financial opportunities there.
00:27:27
Speaker
Other examples in which sustainability really kind of aligns with some of the financial, with some of our financial goals would be there are like we this kind of same conversation about kind of reusable devices and so there are kind of two types of reusable devices there are kind of there's there's some that we call, there's there's device reprocessing, and then there's kind of durable, reusable equipment. So durable, kind of reusable equipment, that falls into the category of um your surgical instruments that get used.
00:28:01
Speaker
They then get to our, they go to our central processing department, they clean them, sterilize them, and then they get kind of like put back into use. They just kind of like get used over and over and over and over again.
00:28:12
Speaker
um There's another category of kind of reusable devices, um which we call kind of reprocessing. And technically, these are devices that are labeled um and by their manufacturer as single use devices.
00:28:28
Speaker
But the FDA has approved third parties who can verify that their processes are allow those devices to be sterilized and reused without compromising their efficacy or increasing infection risk.
00:28:45
Speaker
um And so those so those are So both of those have been shown to be cost-saving. So reprocessing, single-use devices, some examples are like EP catheters, but there are many other types of devices that can be reprocessed reused.
00:29:05
Speaker
Definitely saves health systems money. Most of the studies looking at kind of reusable equipment when compared to their single-use counterparts have also showed cost-saving. So So there are many situations in which kind of sustainability aligns with the health system's financial goals. um That's not true for everything.
00:29:26
Speaker
um But then I think it starts to depend on like what scale you're looking at, right? So there are things that can be, that might be, that might not support a health system's financial goals, but reduce health care costs at like the national level. So an example would be colon cancer screening. Right now, there are kind of multiple ways that you can screen for colon cancer.
00:29:55
Speaker
could be with a colonoscopy. it can be with a kind of stool test. um Although this analysis has never been kind of formally done, i am fairly confident that the stool-based kind of test for screening for colon cancer is associated with significantly lower environmental impacts than a colonoscopy.
00:30:16
Speaker
um And so, but if from the health system's perspective, they make, they may make more money doing colonoscopies than they do doing kind of stool based colon cancer screening, it depends on a lot of factors, but but at the But at the kind of national healthcare level, if we kind of adopted stool-based colon cancer screening as our preferred approach to screening for colon cancer, it is quite possible that we would save a lot of money, right, instead of paying for everybody to get colonoscopies. So um so I think a part of, like, whether or not this makes sense from a health system level
00:30:57
Speaker
depends on like the scale at which you're a bit on the scale and of the scale of kind of the way in which the finances and the money flows.
00:31:08
Speaker
um So that's kind of like the financial piece. There's some things that clearly save money. There are others where it's not as clear. There's some things that are just going to cost money. But um again,
00:31:19
Speaker
they may cost they dont they may seem to cost money because we completely externalize the cost of the environmental impacts, right? If we kind of put ah cost ah a kind of a social cost of carbon on kind of everything that happened within healthcare, then that would be, it would kind of change the way we think about the financing of these sustainability efforts. Yeah.
00:31:43
Speaker
then there there But there are other kind of benefits to a health system as well. One is we're seeing that people increasingly care about this issue. And we think it's an important kind of employee engagement strategy and that people want to work for a health system.
00:32:01
Speaker
that they feel is kind of living its values, particularly around this issue as it becomes kind of more and more prominent within kind of like our everyday consciousness. And so um so I think there's kind of a real opportunity for employee engagement, particularly at a time where like staff morale is in medicine seems to be at like an all time low.
00:32:25
Speaker
Um, so working for an organization that seems to kind of really care about environmental issues may be a well way of help kind of helping people to kind of,
00:32:35
Speaker
um be more appreciative of the kind of company that the organization that they work for. And I think it's like, it gives people a way to kind of engage in this and feel like they're doing something positive. That's beneficial, not only for the patient directly in front of them, but kind of more broadly on an issue that they know is perfect, profoundly impacting human health.
00:33:00
Speaker
Yeah, that's really cool. I never really thought about it from an employment, employee engagement perspective. And like, you know, hospital and organizational morale overall, but that makes a lot of sense that ah that could be a huge part of developing like a good culture at an institution.
00:33:17
Speaker
um And there may be kind of some kind of like PR benefits to it as well. Like I think in general, people are more aware of this issue and are often making kind of like purchasing decisions based on kind of environmental issues.
00:33:35
Speaker
performance and considerations of whatever that kind of whoever the manufacturer of that product or seller of that product may be. And we may see that translate into healthcare as well, right? that you can That you can kind of increase interest in people coming to your health system if they know that you are trying to practice medicine in a way that is doing kind of minimal harm to the environment.
00:34:03
Speaker
I want to ah kind of zone in more now on like point of care, patient care.
Communicating Climate Change to Patients
00:34:08
Speaker
um i know you have like a 10 word message you also you often ah discuss with with patients related to to climate health. Can you kind of just talk about ah your interactions with patients around climate change and what those conversations look like?
00:34:24
Speaker
Yeah, I think it depends a lot. And there's a lot of, I would say, debate out there about the degree to which we should be talking to patients about climate change. And one end of the spectrum is that this is something that doesn't belong in the exam room. It's too politicized.
00:34:41
Speaker
We shouldn't be kind of like proselytizing about climate um in something that's not kind of direct, in a way that's not directly related to that individual's care.
00:34:52
Speaker
The other end of the spectrum would say um research shows that that physicians are some of the most trusted messengers around kind of climate change and how it's adversely affecting human health and that we should be kind of using that, um, using that kind of voice to help people understand that climate change is a health crisis. Um, and essentially you kind of try to depoliticize the issue. My, i think I've kind of, and and I, and I think you can find evidence to support kind of the argument on either end of that spectrum. Um,
00:35:30
Speaker
My feeling is, i and I think this is just may reflect kind of where I am as a clinician, is I kind of follow my patient's lead and try to kind of gauge how receptive they are to hearing about it and really try to keep it focused on their health. So if someone's coming in and telling me that their allergies seem so much worse this year, or like they normally kind of don't get allergies in November, but this year has been particularly bad,
00:35:57
Speaker
then i may kind of try to introduce kind of, you know what, it may be because that's because of climate change. And so begin to kind of bring it up when it seems directly relevant to that person's own health. um If I'm providing, again, I'm a primary care doctor, he's a primary care doctor, so I thought it do a lot of kind of like preventive counseling. If I'm talking to someone about diet And we're talking about kind of like the benefits of a plant forward diet. Then I might also mention, you know, this also not only is it beneficial for you, but it helps kind of address kind of the climate crisis, um, which in itself is having kind of potential adverse effects on your health. So i I try to do it within the kind of context of just discussions that are already happening around people's own health.
00:36:43
Speaker
One, i think caveat of of that is um we we may fall into the trap of using, like, you know, I think after working with patients, you know people's kind of like, after you, you like, as a primary care doctor and you kind of work with patients kind of longitudinally, you get to know them and you kind of begin to understand people's political leanings, then you might be kind of like less willing to kind of engage on that with patients who seem to be kind of more right-leaning than more kind of left-leaning.
00:37:17
Speaker
But interestingly, there's some some data out there that shows, you remember I mentioned that um overall kind of physicians are considered one of the most trusted messengers around kind of the impacts of climate change on human health. and But if you kind of break that down by political leaning, essentially,
00:37:40
Speaker
positions rank lower amongst people who are more left-leaning politically in terms of their, how reliable or how like cross how trustworthy a messenger they are um around the impacts of climate change on human health.
00:37:56
Speaker
Whereas kind of more right-leaning individuals physicians are kind of like up at the very top. And so in some ways, if the goal is really to kind of use this opportunity to help people understand this relationship with between climate change and health and why it's critical for um for us to be addressing climate change as a kind of public health threat,
00:38:21
Speaker
There seems to be kind of like the most value in talking to our patients who are more kind of like right leaning about it, at least based on this one study. um But it's it's interesting because I think many of us would say like, oh, I don't want to bring kind of like politics into the exam room.
00:38:37
Speaker
And so might be less kind to kind of have this conversation with patients who are a little more kind of right leaning. But in fact, this data would suggest we should be taking the opposite approach. So um I think this is true about kind of many things around climate change and health, as well as healthcare sustainability. We have to be really careful to kind of like check our assumptions, because often they're not correct.
00:38:59
Speaker
And we need to be relying on kind of data and evidence to really kind of drive what we're doing. I want to get it inside your headspace a little more ah with regards to your work about climate health. Do you feel like doing this work is like particularly emotionally taxing? Can it be kind of a downer at times in feeling that we're we're up against this great public health challenge that ah can sometimes feel like we're not very making very much progress on?
00:39:28
Speaker
Yeah, it's it's a great question. and I think I find myself on kind of like both ends of the spectrum sometimes. um On the one hand, i feel like because of my work, I'm a little bit more forced to kind of like immerse myself in...
00:39:46
Speaker
everything that we hear about climate and um and its impact not just on human health, but more broadly. And so I don't have the luxury of kind of just like putting my head in the sand and ignoring the news um like some other people may be able to.
00:40:03
Speaker
um But on the other, i would say I feel like the work that I'm doing is kind of like, is really a way of having an impact. And so, you know, I think, like, I do believe in this kind of idea that that action is the antidote to despair. um And so every day I kind of do my work in this area, I feel like I'm doing something to address this problem. And I think that's challenging for people in general, because it is such a kind of massive, overwhelming problem. It's not clear how individuals should be engaging on this on a regular basis in a way that's going to um have a significant impact. That's not to say there aren't ways that people can do it, but I think for the average individual, it's really hard to kind of understand like, okay, how is making this kind of like change my and own individual behavior um going to have a meaningful impact? That can be
00:41:01
Speaker
very discouraging. um But by virtue of my job, I kind of like I every day i kind of like I'm involved in kind of like specific actions that are going to work to address this crisis. And so um to me, that's both.
00:41:19
Speaker
It's, it's, I think that kind of provides me with energy and kind of like the desire to kind of engage on
Career Advice and Healthcare System Focus
00:41:26
Speaker
this topic. But again, it's because I think there's some like concrete ways in which we can be, be addressing the problem.
00:41:31
Speaker
um And I think once people will kind of confine those things, then it can be motivating. With that, it's time for a lightning round, a series of fast-paced questions that tell us more about you.
00:41:43
Speaker
ah So I know you went to to medical school in Philadelphia. You practice in in Boston now. So I want to hear your take on on Boston versus Philly. Like what which city do you like better? So I did my so i did my residency in Philadelphia. um I have to say i you know i'm I'm from Boston.
00:42:01
Speaker
So I have a special kind of affection for Boston. um But honestly, i love Philadelphia. It's just like really... it's ah It's a fascinating city. It's very, it's kind of like a little rough around the edges, which I like, but it has like wonderful kind of culture, food.
00:42:20
Speaker
um It's beautiful, lots of history. Boston has lots of history too, but I don't know. i think, you know, I'm kind of, my roots are here in Boston, but I find Philadelphia to be a really interesting and city. i was I was sad to leave when it was time for me to move on from residency. Yeah.
00:42:37
Speaker
Um, what's your go-to workday breakfast? Hmm. Whatever my kids haven't finished primarily. and mostly have, uh, kids breakfast scraps.
00:42:53
Speaker
What's your ideal Saturday afternoon? In the winter, skiing. In the summer, anything on the water with my kids.
00:43:05
Speaker
What's the best piece of advice you've received?
00:43:10
Speaker
Or just a very very good piece of advice yeah yeah in general. We don't have to... Yeah, this is a good one for, i think, for people who are in medicine. that Our former program director um used to say, make everything twofer.
00:43:27
Speaker
So if you're going to... like You get pulled in so many different directions in a career, particularly in academic medicine, and you can't And so you have to kind of like choose to engage and devote your time to the things that kind of benefit you in multiple ways.
00:43:48
Speaker
um Because if you just try to do kind of like individual things that have like just like one kind of beneficial outcome for you. um It's just kind of overwhelming, you'll end up having to do too many things, you need to find the things that kind of check multiple boxes for you.
00:44:04
Speaker
um It's really good advice in medicine. Yeah, that is great advice. And lastly, ah what's one change you'd like to see in healthcare? m I would love to see kind of at a high policy level, far more emphasis on disease prevention and less kind of focus on kind of just curing disease, right?
00:44:28
Speaker
we We spend, our whole health system is kind of designed and um operates around a model of really trying to kind of care for people once they're sick.
00:44:40
Speaker
I think we need to completely flip that approach and focus on keeping people healthy in the first place. Dr. Greg Fury, thanks so much for joining the show. Yeah, thank you so much for having me. It's been a pleasure.
00:45:02
Speaker
Thanks for listening to The Wound Dresser. Until next time, I'm your host, John Neary. Be well.