Concern has been raised that there is a potential for over treatment of NMSCs among older patients, given the relative low risk of the tumour to their health and the high burden of treatment. This article explores one patient’s perspective of the treatment of multiple NMSCs.
Global warming is becoming an increasingly urgent area of concern, and the field of healthcare is not exempt. This study examines the role that satellite clinics play in reducing the production of carbon emissions, and making our practice more sustainable and carbon-neutral as a result.
The healthcare sector is responsible for 4.4% of global greenhouse gas (GHG) emissions. To limit global temperature rise by 1.5 °C, as called for in the Paris Agreement, GHG emissions will need to be significantly reduced. As climate change has been labelled the greatest threat to global health in the twenty-first century, all healthcare professionals must attempt to promote sustainable practice where possible. The British Society of Dermatological Surgery sustainability guidelines published in 2022 advocate multiple strategies for improving sustainability in skin cancer surgery, including a reduction of activity via prevention measures, low-carbon alternatives, operational resource use and research and innovation. It is recommended that ‘see-and-treat clinics’ should be offered where staff and facilities are available, as one of several methods to lower the carbon footprint of dermatological surgery. We performed a cross-sectional study in a single tertiary dermatology department, focusing on carbon dioxide (CO2) emissions associated with travel to and from skin surgery appointments from 1 January 2022 to 31 December 2022. Our dermatology department is located in an urban area and also receives referrals from rural locations. The distance from the patient’s home to the hospital was calculated in kilometres using Google Maps. Total CO2 emissions were calculated using an online calculator recommended by the Environmental Protection Agency of Ireland and were reported in metric tonnes of CO2. Fuel consumption was based on the average car with unknown fuel. In total, 2358 procedures were performed on 2184 patients, 54% of whom were male (n = 1180). The total distance travelled by patients was 109 787.94 km, averaging 50.27 km per patient (range 1.3–168). This generated 18.74 metric tonnes of CO2 emissions. Eighteen per cent (n = 389) of patients underwent surgical procedures on the same day as their outpatient clinic. Same-day surgery led to a reduction of 35 275 km, averaging 90.68 km per patient (range 1.3–120). This represented a reduction of 6.02 metric tonnes of CO2 emissions. This is equivalent to the CO2 emitted from six transatlantic flights. In our department, absorbable sutures are used, where possible, to reduce unnecessary travel to our department or to a general practice for suture removal. Results for benign lesions are communicated via letter, to minimize return to the clinic. This study highlights the reduction in CO2 emissions associated with same-day dermatological surgery. The limitations of this study include an assumption of travel to and from hospital appointments by car and of travel from the address stated in patient records. Dermatologists should consider the environmental impact of skin surgery and implement sustainable options when service planning.
Conflict, war or economic hardship often causes refugees to flee their communities. The recognition of refugees as a diversified group from a medical aspect is one of importance as they have a range of health needs that differ from the native population. Based on a review of the published literature and cases we have reviewed in our dermatology department, we would like to outline an overview of the challenges associated with managing skin conditions for migrants and refugees, as well as key opportunities to improve care for this community. The initial barrier experienced is primarily related to communication difficulties. Healthcare providers meet obstacles in trying to communicate effectively with refugees as translation services are not always readily available and the waiting time involved for such services results in a further delay in patient management. It came to our attention that refugees often do not communicate all their issues or symptoms because of other complex social issues that take precedence over their symptoms. A separate, substantial issue arises given the lack of documentation regarding their medical background and previous and current treatments. Other challenges faced are the costs associated with accessing pharmaceutical products and not having primary care physicians. Furthermore, staying in temporary accommodation makes it more likely that they will not receive follow-up appointments, resulting in future missed appointments. Overall, refugees are a vulnerable cohort and a substantial multidepartment effort should be made to ease their integration into national healthcare systems.
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