Educating Physicians About Environmental Health: The Case of Unconventional Natural Gas Development

Abstract

Background: Pollution is responsible for at least 1 in 7 deaths worldwide. Medical professionals at all stages of training, however, have precious little education on the ways in which the environment affects human health. In regions of Pennsylvania and Ohio, a new environmental threat, unconventional natural gas development (UNGD), has emerged. We assessed what healthcare providers in regions with UNGD know about this practice and its effects on human health. Methods: In October 2014, interviews, focus groups, and surveys were administered to healthcare providers working in the Guthrie Health System (see appendices A, B, C, and D). Guthrie Health System serves the communities of north central Pennsylvania and south central New York State. We targeted physicians in north central Pennsylvania as hydraulic fracturing was banned in New York State. The survey was distributed to approximately 200 healthcare providers in the Guthrie Health System. In the spring of 2016, we decided to survey healthcare providers in additional regions of Pennsylvania outside of the Guthrie Health System catchment as well as Ohio, another state where UNGD was taking place. The survey was modified and distributed to healthcare providers in these areas through contacts at the Southwest Pennsylvania Environmental Health Project, located in southwestern Pennsylvania, and the Ohio Environmental Council. The survey was distributed to approximately 200 more providers. Providers’ experiences with UNGD in the clinic and common gaps in their knowledge were identified through coding analyses of the interview and focus group transcripts and through the survey results. Guided by these results, we conducted a comprehensive literature review and designed a video that educates physicians on how to take an environmental health history with specific information about UNGD and its potential impacts on human health. This was published on the Guthrie Health Continuing Medical Education website and is available on YouTube at: https://youtu.be/X8EU_Y0xzBo. Results: Fifty-five physicians, nurses, nurse practitioners, and social workers participated in this study. We conducted four individual interviews and two focus groups (of 11 and 8 people). Thirty-two individuals responded to the survey. Approximately half of the survey participants had seen at least one patient with a health concern that the patient believed was related to UNGD. Patients included well site workers, truckers involved in transportation of materials and natural gas, and residents of the communities in which UNGD was occurring. One third of survey participants had suspected at one point that a patient’s symptoms were caused by UNGD. Over 80% of the participants at Guthrie wanted more education on the topic. 20% of the participants in the second round of surveys felt that their educational needs were unmet. To date, twelve providers at Guthrie have watched the video on the Guthrie Health CME website. Two-thirds of participants felt that the learning activity improved their ability to describe UNGD, identify exposures of concern related to this practice, describe its health and socioeconomic impacts, and conduct a pertinent environmental health history. One-third of participants reported that the content will enhance their practice and improve patient outcomes. Conclusion: Communities in regions of Pennsylvania and Ohio are facing a new environmental threat in the shape of UNGD. Healthcare providers have seen patients with symptoms that they and their patients believe could be related to this practice. However, many physicians do not feel knowledgeable enough to address these concerns. The video that we created is one step towards educating healthcare providers, but more must be done to improve general education in environmental health throughout medical training.