Why a B.C. doctor says it’s time to include climate change as a part of diagnoses

A British Columbia doctor says it’s time for physicians to begin including climate change as a part of medical diagnoses.

Family physician Dr. Kyle Merritt was working at the Kootenay Lake Hospital and his own clinic this summer when the province was hit by the deadly and unprecedented heat dome, followed by weeks of intense wildfire smoke.

As the number of patients presenting for care surged, he saw a woman in her 70s with congestive heart failure and diabetes, both of which had been exacerbated by the non-stop heat. Discharging her home, to the same overheated conditions, would only make her situation worse, he said.

Merritt admitted the woman to hospital, and added something to her chart he’d never written before: “climate change.”

“When I was documenting, the diagnosis that I put in the chart is congestive heart failure exacerbation — but what I’m talking about (is) what are the antecedent parents, whether they’re triggering things that are going to cause that exacerbation?” he said.

“What we’re really trying to think as physicians about the underlying causes of what’s bringing our patients in, and that was definitely something that came to my mind … of course, it’s not easy to link these things always together.”

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Merritt said over the course of the summer, he added the term to the medical records of a handful of other patients where he felt it was clear unusual and extreme conditions, including heat and wildfire smoke, were critical to their health problems.

He stressed that he had not actually diagnosed anyone with “climate change” as an illness, but said it can’t be ignored as a contributing factor in some cases.

“If you’re sitting in your house and you don’t have air conditioning, with temperatures above 30 C, especially when it’s not cooling off at night, you get dehydrated, that makes it harder to manage your blood sugar, then your diabetes goes out of whack, which makes it even harder and even more likely to get dehydrated, and then you show up in the emergency department,” he said.

“So if you can say we think that heat dome was directly related to climate change, and those temperatures, certainly we could see the direct impact … that we could attribute to the heat dome, then I think it’s reasonable to think OK, well as physicians, we need to think what are the underlying causes that bring people in to see us.”

Dr. Chris Carlsten, head of UBC’s division of respiratory medicine and director of the Air Pollution Exposure Lab, said this summer’s extreme weather highlights the current gap between climate science and medicine.

Carlsten said there is a clear link between heat and death at a macro level, but that making connections between extreme weather and individual cases is more complicated.

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“That’s why we feel that we need to have ongoing research so we can make that connection even tighter and we can make the case even stronger for doing something more aggressive about these environmental problems,” he said.

With research and experience showing extreme climatic events — including heat waves and wildfires — are becoming ever more frequent, he said access to simple items like air filters and air conditioners should potentially be looked at as a human right.

“Before those long-term (climate change) solutions are a reality, every summer, presumably we can expect there’s going to be something like this,” he said.

“And people that can’t afford air conditioners that don’t have them, they really should be supported by the government because, otherwise, we’re just letting everyone down — and we’re not talking about minor issues, we’re talking about deaths. Nearly 1,000 last summer alone.”

Back in Nelson, Merritt said he understands his move to include climate change as a part of a diagnosis has caused an international stir, but he’s hopeful.

He and a group of local health-care workers have banded together to form a group called Doctors and Nurses for Planetary Health, though Merritt took pains to stress he is a doctor, not a climate scientist or an activist.

“Many of us decided that it’s sort of our role to advocate for the most vulnerable of our patients,” he said.

“Many of the physicians that I work with see this as a big public health issue … as family doctors we’re actually able to see people from all walks of life, from cradle to grave, we’re sort of seeing the impacts become more and more significant, so we’re sort of feeling compelled to be advocates for our patients to speak up about this issue.”

-With files from Ted Chernecki