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When Michael Howard arrives for a checkup with his pulmonologist, he worries about how his body will withstand the heat and humidity of summer in Boston.
"I lived in Florida for 14 years and I came back because the humidity rate was too high," said Howard, pulmonologist, Mary Rice, while he was installing in a test room chair at a Beth Israel Deaconess HealthCare clinic.
Howard, 57, has COPD, a progressive lung disease that can be exacerbated by heat and humidity. Even in a comfortable, air-conditioned room, her oxygen levels worry Rice. Howard reluctantly agrees to try to use portable oxygen. He is resigned to wearing the clear plastic tubes attached to his ears and inserted into his nostrils. He badures Rice that he has an air conditioner and that he will stay inside in very hot weather. The doctor and the patient agree that Howard should walk around at night to make sure he gets enough exercise without too much heat.
Howard then turns to Rice with a question she did not ask in medical school: "May I ask you: Last summer, why was it so hot?"
Rice, who studies air pollution, is ready.
"The general trend of the hottest summers we observe [is] According to Rice, "because of climate change, we have the consequences of climate change with the general upward trend".
For Rice, combining these consequences (heat waves, more pollen, longer allergy seasons) with the health of her patients is becoming a routine. She is part of a very small but growing number of doctors and nurses who discuss these links with patients.
In June, the American Medical Association, the American Academy of Pediatrics and the American Heart Association were among the 70 medical and public health groups that issued a call to action asking the US government, corporations and leaders to recognize climate change as a health emergency.
"The health, safety and well-being of millions of people in the United States have already been affected by man-made climate change, and the health risks are dire in the future without urgent action to combat climate change, "said the coalition statement.
The World Health Organization calls climate change "the greatest health challenge of the 21st century," and a dozen US medical societies urge action to limit global warming.
Some companies provide patients with documents explaining the badociated health risks. But none of these guidelines explain how providers should talk to patients about climate change. There is no concrete list of "backs" – like wearing a seatbelt, using sunscreen and exercising – or "not doing" – such as smoking no smoking, no not drink too much and do not text driving.
According to Rice, climate change is different because a patient can not prevent it. Rice is therefore focusing on the measures that her patients can take to deal with the consequences of heat waves, more powerful pollen and a longer allergy season.
That's the main complaint of Mary Heafy. At age 64, asthma is worse during the allergy season. During her meeting with Rice, Heafy wants to know if she is taking the right drugs. But she also wants to know why her eyes and nose run and her chest is stretched for longer periods each year.
"It's like once [the allergy season] It starts in the spring, it does not end until there is deadly frost, "Heafy told Rice with some exasperation.
"Yes," agrees, "because of global warming, plants bloom earlier in the spring, and after hot summers, trees shed more pollen the next season, and ragweed spreads more long in the fall. "
Thus, Heafy may need more powerful drugs and more air filters, says his doctor, and spend more days wearing a mask, although the effort to breathe through a mask is painful.
While she and her doctor are finalizing a prescription plan, Heafy observes that "doctors talk about things like smoking, but I do not know if every doctor is talking about the environmental impact."
There are many reasons that few do. In addition to the lack of guidelines, doctors say they do not have the time, during a 15- to 20-minute visit, to tackle something as complex as climate change.
And the subject may be controversial: although a recent Pew Research Center survey reveals that 59% of Americans think that climate change affects their local community "a lot or sometimes", only 31% affect it personally and opinions vary considerably according to political circles. Party.
We contacted energy trade groups to ask them what role – if there was one – medical service providers should be involved in the climate change discussion, but neither the American Petroleum Institute nor the American Petroleum Institute. American Fuel and Petroleum Manufacturers have not responded to calls or requests for comments by email.
Some doctors worry about questioning a patient's beliefs about a sometimes difficult topic, according to Dr. Nitin Damle, former president of the American College of Physicians.
"It's a tough conversation to have," said Damle, who practices Internal Medicine in Wakefield, RI. "Many people still think it's something that will not affect them, but that's not the case. Is really not true. "
Damle says that he "takes the temperature" of patients, with some general questions about the environment or the weather, before deciding whether he will suggest that climate change is affecting their health.
Gaurab Basu, a primary care physician at the Cambridge Health Alliance, says he's ready if patients want to talk about climate change, but he does not talk about it. Basu says that he has to make sure that patients feel safe in the examination room. Raising a controversial political issue could undermine this sentiment. When patients ask questions about climate change, it can be "a tough conversation," he says.
"I have to be honest about the science and the threat that exists, and it's pretty alarming," Basu said.
So alarming that Basu says he often refers patients to counseling services. Psychiatrists concerned about the effects of climate change on mental health say that there are still no standards of care in their profession. They suggest that an answer must be tailored to each patient, but some common answers appear.
"We are hungry for information"
An environmental group is not waiting for doctors and nurses to find out how to talk to patients about climate change.
"We are trying to create a demand for these conversations to be launched," said Molly Rauch, director of public health policy at Moms Clean Air Force, a project of the Environmental Defense Fund.
Rauch urges the more than one million members of the group to seek advice from doctors and nurses. For example: when should parents keep children indoors because the outside air is too dirty?
"It's not too scary for us to hear about it," Rauch says. "We are hungry for information about it, we want to know."
But Rauch says that it does not appear that climate change is invading the medical world as a health problem. One study found that courses on environmental health or global warming only covered 20 of the 140 medical schools in the United States.
Some schools of nursing add climate-related courses to their training to prepare students for conversations with patients.
"Nurses must catch up," said Patrice Nicholas, director of the Center for Climate Change, Climate Justice and Health at the Institute of Health Professions MGH in Boston.
Nicolas attributes this delay, in part, to politics. "Climate change really needs to be reformulated as a public health problem," Nicholas said.
The few doctors and nurses who started discussing climate change with their patients say that they did not have a lot of reluctance, but that may be because the introduction of the Climate change in the exam room is still brand new.
This story is part of NPR's reporting partnership with WBUR and Kaiser Health News, an independent editorial news service of the Kaiser Family Foundation.
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