Few medical residents learn about the health effects of climate change. Now as wildfires sweep the West and hurricanes flood the Gulf Coast, the first published guidelines offer a way to start.
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Teaching doctors about the health effects of climate change is growing from medical schools to the residency programs where new physicians put their skills to the test. But skeptics wonder if it’s appropriate for doctors to learn how climate change can affect human health. Martha Bebinger of member station WBUR in Boston begins her story in a clinic exam room.
GAURAB BASU: Well, Steve, I just remember for so many months, it was hard for you to walk.
MARTHA BEBINGER, BYLINE: There are three people in this exam room – Dr. Gaurab Basu, a resident he’s training and 71-year-old Steve Kearns, who is recovering from West Nile virus. Kearns remembers the mosquito bite on his neck but very little about the brain infection that landed him in the hospital for a week.
STEVE KEARNS: For at least six months after that, I felt like every five minutes, I was being run over by a truck. I couldn’t work. I couldn’t walk very well, and I couldn’t focus. I wondered for a bit if I’d ever get better.
BEBINGER: Now, almost two years later, Kearns says he’s back to about five hours a day on the job, making windows and doors. And he started reading again.
CHARLOTTE RASTAS: It sounds like you’ve made tremendous progress.
BEBINGER: Dr. Charlotte Rastas is a third-year primary care resident at Cambridge Hospital.
KEARNS: It seems like there’s progress.
BASU: But it was scary.
KEARNS: It was scary. It was definitely scary, yes. And I’m not scared anymore, although – can I get West Nile virus again?
BEBINGER: Dr. Basu sympathizes with the fear. West Nile is still rare. There were no cases in Massachusetts before 2002. In 2018, the year a mosquito bit Kearns, cases had climbed to 49.
BASU: Mosquitoes love warm temperatures. And so when temperatures increase, mosquitoes can have longer breeding seasons. The virus itself, West Nile, can replicate faster, and they bite more. They’re more active.
BEBINGER: Basu learned a lot of this while treating Kearns. He was Basu’s first West Nile case.
BASU: When someone comes in with a fever and is confused, it’s not what my mind thinks of as the diagnosis right away. This case has really taught me how much I need to be informed about the ways in which climate change is changing the patterns of infectious disease around the United States.
BEBINGER: To inform his residents, Basu added the health impacts of climate change to an elective course he teaches. Rastas says residents need much more.
RASTAS: This is something that needs to be more directly integrated into the curriculum because I think it’s going to have such a huge impact on human health.
BEBINGER: There are no approved curricula for hospitals that might want to tell emerging lung specialists about longer pollen seasons as temperatures rise or teach new emergency room physicians to consider more waterborne diseases for patients with fever and diarrhea. But pediatrician Rebecca Philipsborn at Emory University has just published a framework hospitals can use as a starting point.
REBECCA PHILIPSBORN: Patients want physicians to be able to provide guidance on things that affect their individual health. We have this accumulating body of evidence that climate change does just that. It poses harms to our patients.
BEBINGER: Dr. Stanley Goldfarb, the former associate dean for curriculum at the University of Pennsylvania’s medical school, says hospitals train doctors not advocates. He worries that discussing climate change with patients might create mistrust.
STANLEY GOLDFARB: I do think there are concerns about getting into the political sphere because I’m against anything that’s going to represent a barrier between patients and physicians being comfortable with each other.
BEBINGER: Other physicians see wildfires sweeping Western states and hurricanes flooding the Gulf Coast and say…
UNIDENTIFIED PERSON: We want to impart this information to our residents as fast as we can because it’s so important that they gain this information sooner than later.
BEBINGER: Advocates say including climate change in residency training won’t stick until doctors are tested on the health effects before they are licensed to practice medicine.
For NPR News, I’m Martha Bebinger in Boston.
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