Teaching Patients Climate Change in Just 45 Seconds: Three Easy Scripts

How can we talk with our patients about climate change and health without disrupting the office visit? Dr. Andrew Lewandowski, a mid-career pediatrician in private practice in Madison, Wisconsin, has found a solution. He struggled for years to find a way to incorporate environmental sustainability and climate change into his practice. He recognized from the start that these topics could be time-consuming and even controversial with the potential to jeopardize the trust of some patients. In his words, the “lack of clinician education, perceived political nature of the issue, and limited understanding of practical prevention all present potential barriers.” Finally, he found few clinical guidelines or standards of care on how to educate patients about the health risks they face and how to protect themselves.

Many professional societies, including the American Academy of Pediatrics, the American Medical Association, and the World Medical Association, urge physicians to incorporate climate change teaching into routine patient care. Until now, there has been no easy way to do this.
Dr. Lewandowski and colleagues offer his solution in a 2021 paper, “Patients value climate change counseling provided by their pediatrician: The experience in one Wisconsin pediatric clinic”*. Lewandowski describes a forty-five second climate conversation that he conducts in the exam room as part of every well-patient visit.

Here is the script for Dr. Lewandowski’s 45-second teaching.  He adds this at the end of his patient history and before starting the physical exam:

“In the last two years, the American Academy of Pediatrics and 100 other health organizations declared climate change a health emergency. Air pollution alone caused over 64,000 premature deaths in the United States in 2016, and worsening air quality is only 1 out of 9 ways that climate change is harming people, disproportionately harming children. So just like I want your children to eat healthy foods and be in the right car seat for their health and safety, we now know that decreasing our energy use, increasing energy efficiency, and supporting clean energy initiatives are also important for improving our children’s health. Any questions?”

Lewandowski received confidential surveys from 138 of his patients after their office visits. The patients were highly in favor of receiving the information and many reported that they were likely to change their choices made at home because of the information that the doctor provided. This was true even for patients who described themselves as political conservatives.

This approach works best, I think, when supported by further resources for patients and families. My Green Doctor provides dozens of free brochures, handouts, and blogs on topics of environmental sustainability, climate change, and health. The brief conversation that you begin in the exam room can continue when you recommend My Green Doctor as a useful tool. Patients can access My Green Doctor for free at MyGreenDoctor.org or at MyGreenDoctor.es. Si, en Espanol tambien!

Dr. Lewandowski’s script is simple, persuasive, and non-controversial. It manages to harness the trust that patients have of their nurses and doctors but without unwisely exploiting that trust. Each nurse, nurse practitioners, and physician can create his or her own short script and find where best to insert it into their office routine.

I’ve written two more scripts for you to consider:                                                                           

“There’s another health issue I’d like to tell you about before we do your physical exam. In the last two years, more than 100 health organizations declared climate change to be a health emergency. Burning fossil fuels is causing climate change, but also creates air pollution that kills more than 64,000 Americans every year and far more around the world. So just I worry about your medical conditions, and eating healthy foods, and wearing your seat belts, I want to share with you that decreasing our energy use and supporting clean energy like wind and solar power, and the use of electric cars, are also important for improving our health. Any questions?”

And here is my third script:

“There’s another health issue I’d like to discuss with you. In the last two years, more than 100 health organizations declared climate change to be a health emergency. This is because burning fossil fuels like natural gas, coal, and petroleum, and how we manage our farms, is causing climate change, but they also create air pollution that kills more than 64,000 Americans every year and far more around the world. So just I worry about your medical conditions, your lab tests, eating healthy foods, and wearing your seat belts, I want you to know that the things your family does for the climate will really help save lives. It’s for better health that we decrease our energy use, support clean energy like wind and solar power, and choose electric cars. Any questions?”

Now you have three scripts with which to build your own! Please send us yours and we will share it with the more than 250,000 health professionals who receive My Green Doctor’s newsletter. You can do this!

Author:  Dr. Todd Sack is Executive Director of the My Green Doctor Foundation that manages MyGreenDoctor.org and MyGreenDoctor.es (en Espanol).  Please share your ideas and your own forty-five second climate change script:  [email protected] .

*Journal of Climate Change and Health, 2021, free online at doi:10.1016/j.joclim.2021.100053.