What a Dermatology 'Carbon Footprint' Actually Means
Shanna Miranti, PA-C, opens by admitting this is a topic she'd never given a second thought, and co-host Jennifer Connor, PA-C, agrees she had to do some homework before the conversation. Their guest, Dr. Riley McLean-Mandell, explains that sustainability, at its core, is simply looking at how we treat our environment and our impact on others — and that a carbon footprint is the way we measure it. Every action we take, and every bit of waste we generate, requires energy to produce and to dispose of, so a footprint is the overall sum of those costs.
McLean-Mandell describes what got her started: she recycled and used cloth at home, then walked into her clinic and 'plastic wrapped the entire room in the name of patient safety.' Dermatology, she notes, is energy intensive. Outpatient rooms tend to be bigger than hospital-based spaces, so they require more energy to heat, cool, and build. Exam chairs and lasers draw significant energy, and procedures generate a lot of waste. Add patient commuting, the medications we prescribe, and the downstream waste they create, and the footprint grows fast.
Three Ways to Audit Your Own Practice
McLean-Mandell offers a practical framework. If you manage the financial side of the practice, start with your top spend items — sterile gloves are her example. Look at how many assistants glove up, whether people re-glove because they forgot supplies, and whether you can tighten the process. If you don't control the budget, walk the patient journey from door to discharge: paper versus digital forms, waiting room temperature, whether every patient really needs a gown (or, as she jokes for the non-New Englanders, a 'Johnny'), and what's on the exam table. She notes there's evidence you don't need anything on the exam table as long as you clean it between uses.
Keep going through the visit: is your biopsy tray overloaded with equipment you don't use? Is the take-home goody bag too full? Are you handing printed instructions when a MyChart message with the after-care instructions would do? The third option is a straightforward waste audit — literally picking through the trash to see what's most abundant and working backward to reduce it. Miranti, a self-described lover of paper handouts, concedes she'll have to reconsider her printing habits; McLean-Mandell suggests switching to double-sided or asking whether the patient will just toss it on the way out.
Where Technology Helps — and Where Greenwashing Muddies the Water
EMRs, McLean-Mandell says, do consume energy for data storage but still beat warehousing and cooling paper records. Telehealth is a big lever because patient commuting hours drive a large share of the footprint. Anything that cuts return visits helps too — she points to dissolving sutures and gel foam after a punch biopsy so patients don't have to drive back. She also mentions an unpublished study comparing iPledge virtual booklets to printed copies, with the spoiler that virtual enrollment is better for the environment and health literature doesn't show patients get much more from a paper copy.
On skincare, Connor asks whether 'clean' and 'sustainable' beauty claims hold up. McLean-Mandell calls out greenwashing — labels that sound green the way a cereal box sounds healthy. For patients worried about health effects, she points to the Environmental Working Group, which, as far as she can tell, lacks major corporate backing. For those worried about environmental impact, she says to focus on packaging and production — where products are made, working conditions, and how recyclable the packaging really is (metal-look tubes often have plastic linings). She candidly walks through her own struggle with vitamin C, which degrades with light and air, and sunscreen, where she'll still grab a Neutrogena stick and a non-recyclable spray bottle for the beach with four kids. Her advice: buy whatever sunscreen your family will actually wear, in the largest size that stays effective, in the most recyclable option available.
Climate, Skin Disease, and Making One Small Change
Looking ahead, McLean-Mandell says clinicians will need to be on their game. Temperature extremes and worsening air pollution are expected to flare atopic dermatitis, disproportionately affecting patients of lower socioeconomic status. Increased UV is associated with increased skin cancer — she references an article by Eva Parker, MD— though she notes the strength of the correlation is still being sorted out. Changing vectors matter too: fewer hard freezes in New England mean Lyme disease may become year-round, and expanding mosquito territory carries mosquito-borne illness with it. Climate refugees will also shift which conditions appear in which regions.
To keep it hopeful, McLean-Mandell reminds listeners that Rome wasn't built in a day — pick one thing. She points to AAD working groups and encourages you to talk with your institution. Crucially, she stresses empowering staff, since the people setting up trays often control the waste: one of her group's derm techs led the switch from single-use to reusable punch biopsy kits. Miranti echoes the theme, telling listeners to be the one person in the practice who raises the topic, makes one change, then reaches for another.