Table 7.

Sustainable patient care and mitigation measures on system level.

Sustainable patient care and mitigation measures on system level
Category	Mitigation strategies
Sustainable patient care	Using less medical material that is nevertheless sufficient for good patient care   using expired sterile bandages as non-sterile bandages e.g. for external applications for wound care   using fewer sugar test strips   thoughtful use of disposable gloves Avoiding drugs that are harmful to the environment, such as   Diclofenac   X-ray contrast agents   Asthma/ COPD medicines with propellants   Avoiding disinfection that is not degradable Using video or telephone consultation for minor issues Cleaning and sterilising medical devices in the practice instead of using single-use devices Avoiding overtreatment   conservative care instead of surgery   reasonable use of treatments Lifestyle interventions instead of prescribing medication (for diabetic patients) Avoiding prescribing antibiotics Supporting prevention Prescribing smaller packages first to test the medication so it won’t go to waste
Sustainable patient counselling	Advising patients on a healthy lifestyle, such as a meatless diet and going by bike or walk Putting information for patients on the practices’ website, using a TV in the waiting area or giving verbal recommendation Using the role of a physician as an educational mandate to inform about climate change and its negative consequences
Politics/system level	Adopt information on sustainability and waste separation into obligatory hygiene training Taking education classes in sustainability for the medical practice Education in sustainable health care, e.g. via podcasts or classes Talking about a sustainable medical practice in team meetings Creating special waste disposals for medications so they don’t end up in residual waste Expanding the durability of medications and medical devices Promoting sustainable healthcare in the media Handing out information on sustainable measures and actions for medical practices Implementing sustainable measures and actions mandatory for medical practices