Thomas Kuczmarski, MD

Just as there is no region of the earth that will escape the effects of climate change, every organ system in the human body will likely be affected by the repercussions of rising temperatures. From the effects of increasing air pollution on rates of asthma to the impact of high heat and humidity on heart health to the rise of tick-borne illnesses in a warming world—the health effects of climate change are myriad. Thomas Kuczmarski, MD, a senior resident in the Brigham’s Internal Medicine residency program, wants to help educate physicians about how to treat the many patients who are likely to be affected by the Earth’s changing climate. Kuczmarski is one of the authors of a recent paper in The Journal of Climate Change and Health that outlines a curriculum for integrating the topic of climate change into residents’ education. Kuczmarski completed medical school at Dartmouth and will be going to Seattle, WA at the end of June to start his fellowship in hematology/oncology.

In honor of Earth Day this month, Kuczmarski answered questions about the intersection of climate change and human health and how the medical community can integrate climate change into education to better prepare physicians for the impact of rising global temperatures.

Q: How did you become involved in work to integrate climate change into residency education?

TK: Just a few months after I came to the Brigham, I attended a Grand Rounds where Howard Frumkin, DrPH, MPH, MD, and Bill McKibben spoke about climate change and human health. The lecture really piqued my interest in the topic. As I progressed through residency, I learned more about the connection between climate change and human health and realized that physicians are in a really unique position to educate people about this connection. Climate change affects everyone, but has a disproportionate effect on the most vulnerable members of our population. So as a physician, it is really important to learn who is at greatest risk and how to mitigate that risk for patients.

I was fortunate to meet some great mentors here at the Brigham and at MGH, and together we realized that more formalized teaching on the health effects of climate change was needed. We wanted to introduce material that was not only novel and informative but actually clinically relevant, so that residents could feel like they had practical skills to improve their daily practice as physicians. The residency program, including the chief residents and the team of physicians in charge of our outpatient curriculum, was very supportive and helped get this project moving. We also found that trainees were really passionate about this topic and wanted to get more teaching on it. During the process, we discovered that we are one of the first residency programs (and possibly the first amongst internal medicine residencies) to have this material in our curriculum, which has made the work even more exciting.

Q: How did you connect with your mentors Greg Furie, MD, Paul Dellaripa, MD, and Caren Solomon, MD?

TK: During my intern year, I heard that Dr. Dellaripa was focused on improving sustainability within the residency (e.g., trying to eliminate plastic, disposable water bottles at our conferences), and he encouraged anyone interested in helping out to email him. I reached out to him, and he put me in touch with the larger group. Drs. Furie, Dellaripa and Solomon have been extremely supportive mentors. As I began working with them, I realized that although I was passionate about the topic, I wasn’t the most knowledgeable — they provided me with a lot of education and guidance to eventually build a foundation of knowledge about the health effects of climate change.

Q: What is the connection between taking care of the Earth and taking care of our health?

TK: It’s easy to forget that the two are actually quite closely connected. If we don’t take care of the Earth, there will be dramatic effects on our health, especially the health of the most vulnerable members of society. Planetary health is a topic that has been gaining a lot of traction in recent years, and part of that may be because we are realizing how inseparable the health of our planet is from our own health. Earth Day provides us with an opportunity to reflect on the many connections between the climate and human health.

Q: What are some of the examples of the health effects of climate change?

TK: When people think of climate change, they may not initially think about the health implications. But climate change and warming temperatures have so many effects on our health. Warming temperatures affect just about every organ in the body. Warmer temperatures are associated with higher rates of heart attack, stroke, and heart arrhythmias. Wildfires, which are increasingly common as temperatures rise, release microscopic or almost microscopic particles that cause a great deal of heart and lung issues when we breathe them in. Warmer temperatures also mean more pollen and a longer allergy season, which can lead to more severe allergies and profound effects for people with underlying lung conditions such as asthma and chronic obstructive pulmonary disease. We’re also seeing rises in kidney disease and gastrointestinal issues. There are infectious diseases that may become more widespread with warming temperatures. Mental health symptoms also increase with rising temperatures, leading to increases in violence and suicidality. Anxiety around environmental changes (known as eco-anxiety) is also an emerging psychiatric issue. These are just some of the many ways that climate change affects health.

Q: How do you build this into a resident’s education?

TK: Incorporating new material into medical training can be challenging. There is so much that already needs to be taught during residency, and often not enough time to add additional content. The method that we adopted is a “train the trainer” approach — we identify experts who are already giving a lecture on a topic, say, chronic kidney disease, and we provide the lecturer with information about the link between climate change and chronic kidney disease and share teaching materials to help facilitate. This allows them to incorporate new information into their current lecture and, in doing so, helps infuse this material into the residency curriculum. We have also been fortunate enough to have a lot of support from the residency to allow some time for some “stand-alone” lectures. These are teaching sessions that are primarily focused on climate change, and we were able to make some of these joint conferences with both MGH and BWH. Some examples of these include talks on Climate Smart Health Care, Climate Change and Physician Advocacy and Climate Change and Environmental Justice.

The other exciting part of our work is that it has led to a multi-institutional partnership through an organization called the Global Consortium on Climate and Health Education. Our goal for this project is to create an open-source repository of climate resources that can be used by medical schools and residency programs. Thus far, nearly 300 medical trainees and faculty from around the world are involved in the project, which highlights the level of interest that medical professionals have in the topic.

Q: How do you stay optimistic while remaining realistic about the effects of climate change?

TK: For me, working as part of a team is key. When I look at how much work needs to be done with regards to climate change, it can be daunting and even a little bit discouraging. But when you’re on a team with a common goal, suddenly that common goal seems a lot more achievable. Working alongside co-residents and faculty members also provides me with a healthy dose of realism—sometimes more experienced faculty can provide helpful guidance on the feasibility of our team’s goals. Lastly, it has been really heartening to see so many medical trainees and faculty interested in collaborating on this project. Because of their support, we wouldn’t have made so much progress, and I’m hopeful that these efforts are going to continue and expand during years to come.