How Can Pathology Preserve the Environment?

A few months ago, when I decided to write about the environmental crisis, I could not have imagined the state of the world as it is today. It seems almost inappropriate to be talking about issues other than COVID-19 in these surreal and devastating times – but, as our routine testing volumes temporarily decrease, it does allow for a period of reflection.

Although I have been enamored with pathology since starting my residency, I am simultaneously dismayed at the amount of waste that we produce on a daily basis. Sadly, we are part of a much greater problem. I learned this year that, if healthcare were a country, it would be the fifth-largest polluter in the world (1). Depressing? Yes. The sector responsible for keeping us healthy is a massive contributor to illness around the world. From vector-borne diseases to respiratory illnesses and food and water insecurity, climate change is expected to have a significant impact on human health in the coming years (2). As healthcare professionals, we must advocate for a healthier world for those we serve.

It is convenient to say that health care is privileged – that our waste is unavoidable to maintain quality standards in labs and to ensure the safety of healthcare professionals and patients alike. Or one might invoke the rhetoric that climate change policy should begin in a top-down fashion from the governmental level. If the COVID-19 pandemic has a silver lining, I believe it’s that we’ve been shown what a profound impact one individual can have. The resilience, creativity, and resourcefulness of my colleagues and neighbors have given me hope in this time of crisis.

So what can we do to help limit the environmental impact of our profession? The answer to that question is nothing new. It centers on the three Rs: reduce, reuse, and recycle. I would add one more step to the beginning – something like “recognize” (to keep the alliteration going) – to remind us to be conscious of our actions and identify areas with potential for improvement. Being more aware of our energy consumption, for example, will become increasingly important as we transition towards digital pathology and start implementing machine learning algorithms into our practice. Many organizations offer ideas from which to draw inspiration for beginning this process. A nice list of resources has been compiled by the Canadian Association of Pathologists (3).

Perhaps the most important R of all is “reduce.” Some reductions you could think about implementing include choosing digital publications over print (I recently changed my subscription to The Pathologist!), streamlining your LIS system to limit reliance on printed documents, turning off computers at the end of the day to save energy, and reconsidering travel to meetings – especially now that we’re all practically experts at the art of meeting digitally!

Reuse is a tricky category. If you walk through your frozen section or grossing room, do you see any single-use items? Could any of your margin brushes, paper towels, specimen containers, or other items be replaced with a more sustainable option – or appropriately washed for reuse without compromising quality? Could you negotiate with vendors to have them reclaim and reuse the packaging that comes with your purchases?

Recycling is the last resort and the most expensive intervention, but up-front costs can be amortized over time or mitigated through funding. For example, we found out that our lab alone uses hundreds of thousands of plastic gloves in a year, so we partnered with other labs in our network and applied for funding from our associated university to institute a glove recycling program. Recycling solvents, done in other labs, may lead to financial gains in the long term. There are many more examples of labs proudly going carbon-neutral, many of whom have posted their “how-to” advice on the Internet.

It remains to be seen whether our experiences during the COVID-19 pandemic will lead to an inflection point in how we treat the environment. I believe that, as healthcare professionals, we have a responsibility to contribute to the health and wellbeing of our patients – not only through the quality of our diagnoses, but also by ensuring that the practices involved in making those diagnoses are in their best interests as well.