Guests: Lisa-Marie Smale, pharmacist and postdoctoral researcher in sustainable medicine use, Erasmus MC; Nicole Hunfeld, clinical pharmacist (intensive care) and Associate Professor in Sustainable Healthcare, Erasmus MC Host: Frederik Dam van Deurs Recorded: October 2026

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Frederik: Hello, and welcome to the Sustainable Healthcare Podcast. I am your host, Frederik Dam van Deurs. Day-to-day, I’m working with Care Pathway Consulting on advising the pharmaceutical industry on the green transition, typically integrating strategy into the line of work, all the way from early discovery to R&D and clinical trials, manufacturing, and with market access and commercial as well.

And in that work, I have been exposed to the concept of deprescription as a lever for decarbonisation. And lo and behold, on LinkedIn, I stumbled upon actually a discussion in the comments between Nicole and Lisa-Marie. So I invited them on the show, and I’m a lucky bastard because they agreed to partake.

So, without further ado, Nicole and Lisa-Marie, welcome to the show.

Nicole: Well, thank you. It’s a pleasure to be here again.

Frederik: Yeah, thank you. Welcome back, Nicole. So I figured for our listeners that we spend a little bit of time getting to know each other, and for me to understand your work before we started this recording.

So, Lisa-Marie, would you go first and introduce yourself to the listeners, and just in one line the project that you’re working on, and then I’ll ask you for the same after Nicole.

Lisa-Marie: Yeah. Thank you very much. One line is challenging, but I will try. So my name is Lisa-Marie Smale. I’m a pharmacist trained by background, and I’m a postdoctoral researcher in sustainable medicine use at the Erasmus University Medical Center in Rotterdam, the Netherlands.

And I’m working on using medicines in a more sustainable way in clinic. And that entails both developing interventions to use medicines in a more sustainable way, evaluating them and implementing them.

Frederik: Okay. So I think that was a really good sort of over-the-fence-to-your-neighbour explanation.

And Nicole, how would you explain what you’re doing day to day?

Nicole: Yes, I’m Nicole Hunfeld. I work at the intensive care unit of Erasmus University Medical Center as a clinical pharmacist, and also as the chair of the green team there. And then also, I am an associate professor sustainable healthcare, so I’m leading a large research group.

And Lisa-Marie is one of the postdocs in my group. And with my group we are decarbonising healthcare, looking into circularity of healthcare, and it’s quite broad. We focus on healthcare pathways, products, and of course also medication. And together with Lisa-Marie, we are looking for strategies to help doctors and physicians in deprescribing, but also to improve their knowledge on sustainable medication use.

Frederik: Amazing. And Nicole, I think you have your fingers in so many pies in the realm of sustainability and healthcare. So the way you’re approaching it now… In the pre-interview, we talked about taking it a few steps back. So if you were to sort of look at it from a planetary perspective, what are the entrances to this realm of sustainability in healthcare?

And what are the major frameworks that you’re using to orient yourself in this transition?

Nicole: It’s really focused on healthcare professionals and patients. I think if you want to change something, in this sense, using less products, medication or whatever you can think of, it’s always a decision made by people, and in this perspective, healthcare professionals.

So for me, they are the most important group. If we don’t know how they think, how they act, what moves them, we cannot change anything at all. So for me, it always starts with who is doing what and why is this person doing it. And with this knowledge, we can then define interventions in a co-creation session, so together, to make sure that everybody knows what they’re doing and especially why people are doing something and why they are making impact.

Frederik: Hmm. So I think during the time we’ve known each other, we have talked about circularity and material flow analysis inside a hospital to understand what is the consumption looking like inside a hospital, and now we’re touching upon deprescription, which is obviously a very different animal on that savanna.

What are the topics that you’re seeing emerging that you’re curious about but not yet working on, if any?

Nicole: Well, I think at the moment we try to cover it all. But getting insights on, let’s say, how doctors think before they prescribe is really essential here. Because of course they’re following guidelines, maybe, and maybe that guideline states that you need to start a drug for a certain patient for a certain indication.

But it comes with a footprint, and maybe a drug is not even necessary, but it can also be something else, a non-pharmacological. But to make that shift, we need to make sure that everybody’s on the same page. We provide them with the information, and again, also numbers, because you just mentioned a material flow analysis.

Yeah, that’s one of our strategies of mapping what happens. And with that map you get data, and data is what’s needed, at least to tell people what they can change and how they can change it. So we try to combine this data in our narrative together with implementation science. So what drives people, what stops them, what are barriers, what are facilitators?

And if you put it all together, you get a map, let’s say a roadmap for change, and I think that’s really essential. It’s not easy, but that’s what’s needed.

Frederik: Hmm. So you are basically looking at turning every stone and figuring out where can we win some of these necessary moves to decarbonise healthcare?

Nicole: Yes, exactly.

Lisa-Marie: Yeah, and if I may add to that, I think the material flow analyses are a really nice way to demonstrate what materials we’re using, also what medicines we’re using. And from a pharmacist point of view, we’re focusing especially on the medicine waste part, because that’s what we see, that’s what we’re disposing of.

And because that’s so visible, I think there’s a lot of motivation among pharmacists to work on that. And I think the MFAs, the material flow analyses, help to also visualise the medicines that are being used by patients.

Frederik: Which is the majority, right, Lisa-Marie? That’s one of your key points, is that most medicines end up in someone.

Lisa-Marie: Definitely. And I’m happy for that, because it’s a waste that we’re disposing of good medicines, and they should be of benefit to our patients. However, the thing is, and Nicole already mentioned that, a lot of guidelines focus on prescribing medicines to treat disease or to prevent disease in some cases.

However, a lot of these guidelines don’t focus on when to stop the medicines. So actually, European research a few years ago showed that up to 70% of the guidelines do not have recommendations on deprescribing. And because of that, it could be the case that a patient starts with a prescription at one point, and then it is continued over time, and no one asks the question, is it still needed?

And I think that’s where we can be more critical sometimes, to regularly evaluate medicines. And that is already done from a clinical point of view in a limited amount of cases, to weigh the effectiveness of treatments against their potential harms. But what we’re trying to do here is also include the environmental perspective there.

Because in terms of circularity, not treating can provide bigger environmental gains than switching to another treatment. As long as it’s still safe for the patient.

Frederik: Thanks a lot for that, Lisa-Marie. And I think you’re really entering a really interesting territory here, because I think you’re absolutely right that waste is typically one of the first and safest places to go when you embark on a sustainability transformation journey, because it’s so easy to see and understand that this waste shouldn’t have happened, these resources should have been utilised better.

And it’s very visual, it’s very comprehensible, and the narrative basically writes itself. But that visibility doesn’t necessarily equate impact. And that’s what you’re really sort of trying to line up here, the way I hear it, is to say, maybe we need to take it a few steps further back and see what could we do even better before this medicine even is prescribed to a patient, ends up in a patient, or ends up as waste.

And I really appreciate that angle of looking a bit more at a strategic level, if you may say so, and also that you looked into the guidelines and found out that 70% of guidelines do not have an explicit deprescription strategy. I think that’s really, really interesting and something that we would need to pick up on if we want to achieve this decarbonisation.

But the way this conversation actually started was in the comments in LinkedIn, so thanks a lot to both of you for engaging in that. And through that path, you linked me on to this survey of 63 doctors. So can you give us a bit more context to what was it you were surveying, where were they, and what did you ask them about deprescription and the environmental impact of medication?

Lisa-Marie: Yeah. Then I have to go one step back, because I’m working for this national implementation programme called Greening Healthcare Together. It’s a national implementation programme in the Netherlands in which we try to implement sustainability measures in Dutch hospitals. So almost all Dutch hospitals are participating, and we’re focusing on making nursing wards more sustainable as well as medicine use more sustainable.

So what we’ve tried to…

Frederik: Just, Lisa-Marie, just for context, for those that don’t know the Dutch healthcare system, it’s mostly national, right? And nursing is part of the way healthcare is governed in the Netherlands, right?

Lisa-Marie: Yeah. We’re looking at the hospitals. So we have about 70 hospitals in the Netherlands, and we’re looking at the specific wards of those hospitals and medicine use initiated by those hospitals.

And medicine use initiated by the hospitals can be either during hospitalisations or by the outpatient clinics.

Frederik: Cool. And it’s mostly public, right? How is the distribution private and public in the Netherlands?

Lisa-Marie: No, it’s sort of public. So we have healthcare insurance, which is obligatory to all citizens, and that covers the cost.

So the first, I think, few hundred euros you have to pay yourself, but then all the costs are covered.

Frederik: So similar to the Scandinavian model.

Lisa-Marie: Yeah, I think so. Yeah. I’m less familiar with…

Nicole: Yeah, that’s quite comparable. Yeah.

Frederik: Okay. Cool. Thanks a lot. Yeah, I think for those not familiar, it’s helpful to have that piece of context.

So you’re looking at all Dutch hospitals, or around half? Or how was the coverage?

Lisa-Marie: Yeah. Almost all 69 hospitals are participating in this programme. And for the medicine parts, we wanted to give them focused interventions, because like Nicole mentioned, I think physicians are quite motivated to work on environmental sustainability, but they don’t know how.

And in this programme, we wanted to make that concrete. So that’s the reason why we did this survey in the first place.

Frederik: And what did you ask?

Lisa-Marie: Yeah. So our question was, for the most commonly prescribed drugs by Dutch hospitals, what sustainability measures could be implemented in Dutch hospitals?

And we focused on two types of strategies. So the first one was switching to a more sustainable dosage form. An example there would be the inhaler case. So switching from a pressurised metered dose inhaler to a dry powder inhaler. It’s basically the same medicine, but in a different, more climate-friendly form.

And the other side was deprescribing. So looking at what medicines are maybe used unnecessarily, and to see if we could prescribe less there.

Frederik: And what would examples be of that?

Lisa-Marie: So we focused, for instance, on opioids after discharge. So we see that sometimes patients get a lot of opioids going home after, for instance, having a surgery, while they only need them maybe for a few days, or maybe they don’t even need them.

So one thing is to reduce the amount of opioids being prescribed at discharge.

Frederik: Hmm. And that’s a doctor in the hospital that prescribes that, so it’s not your own personal doctor?

Lisa-Marie: Yeah, yeah. Okay. That’s being prescribed in the hospital. But yeah, you are using it then in your home setting, but it’s initiated in the hospital.

Frederik: Yeah, and I think anyone who’s been to a hospital has tried leaving the hospital with a bunch of pills.

So that’s one of the cases that you’re looking at. Then you also mentioned this case, I think it’s in the paper, of switching paracetamol from a drip to a tablet. And would that be an example of what you’re mentioning here, of changing the dosage form to a more sustainable form, where the drip carries a higher carbon footprint compared to a tablet?

Or is it that you get a smaller dosage or more sustainable amount of the drug? Or can you walk us through that example?

Lisa-Marie: Yeah. So this is actually a more sustainable dosage form, because the dose is equivalent for paracetamol, whether you use IV or a tablet. We use an equivalent, so the same dose, so the same amount of active pharmaceutical ingredient.

And because of all the materials that you need for administrating IV treatments, so think about the infusion bag and all the plastic materials that goes by it, it’s way more sustainable to use an oral product, like a tablet, instead. Research showed that the carbon footprint of this tablet is 12 to 16 times lower compared to IV per dose.

But that’s only the case if the dose is equivalent. So Nicole and I already had a lot of nice discussions on this, because people then learn, “Oh, oral treatment is more sustainable than IV treatment.” But that’s only the case if the dose is equivalent. Because what sometimes happens if you’re treating orally, the medicine has to be absorbed.

And if that is a suboptimal process, we need a higher dose orally compared to IV, where all the active ingredient comes available immediately. So if that’s the case, we have to do a proper evaluation, and you can’t say that oral is the more sustainable dosage form. However, for paracetamol, it is, due to the equivalent doses.

Frederik: Hmm. So I think in other conversations where I’ve stumbled upon this, the term bioavailability has come up, where one of the issues with oral treatment versus particularly injectables has been that the bioavailability has not been at a similar level for the orals. So sometimes they have needed nine times the amount of API to achieve the same effect, and that’s what you’re lining up here, is that you would need to have similar dosage and comparative effects for this to work.

So if the bioavailability on oral is too low, it could actually offset the gain of switching away from an IV in some cases, because you would need to have much more API. Is that correctly understood?

Lisa-Marie: Definitely.

Nicole: Yeah, I think there’s also a bit of a rule of thumb there, that you need at least a bioavailability of 70 to 80% anyway to make the switch.

Otherwise it can also be unsafe for the patient. So that’s a bit what we do.

Frederik: And is that, Nicole, that rule of thumb, is that written explicitly anywhere, or is that something you intuitively know as a doctor by training, or how is that knowledge?

Nicole: Yeah, that’s a bit what we see in the recent literature about these switches. More people are working on it, and this is a bit the overall rule, I think, that shows up, which makes sense, I think, from a pharmacological perspective.

Frederik: I won’t be the judge of that, but I trust your call on it. Cool. So in looking at this paracetamol case, was there anything that surprised you, both in terms of how the panel was engaging with it, or which examples they turned down? So you brought a number of examples to them, and then this is just one of them.

But, you know, looking at all of the options that were put forth, what surprised you in how they responded to it?

Lisa-Marie: Well, they were really enthusiastic about switching paracetamol to tablets. And I think that is due to a national campaign that we already did, or especially Nicole already initiated.

So it might be nice, Nicole, if you could tell a little bit more about that.

Nicole: Yeah. Years ago, I started the paracetamol challenge based on my experience in our own ICU, where we made the switch. And in the beginning, we had no idea what our goal could be, so we just stated together with the green team, “Let’s go for 25% decrease in IV paracetamol as a start, and let’s make it a challenge so people feel really inspired and also motivated.”

So we started the challenge with a 25% reduction of intravenous bottles. And in my ICU, within one month we already had 50% decrease, so it was very successful. And what I noticed then, that the nurses were taking the lead there. So the nursing professional part is really important here.

They really like to ask these questions to the intensivist, and they were making, I think, this really successful. And in the beginning my focus was not on the nurses specifically. I mean, we made a nice poster, but I thought the intensivist would really drive this, or at least the medical doctors within the ICU. But the nursing staff really helped me out there, and helped us out, to be honest, and they’re still doing this. So they’re really keen on this switch now. And they know that they can make impact on the environment with it. And I didn’t expect that to happen. But we had a little bit of magic there.

Frederik: Yeah. I think something that might be also underestimated here is that the nurses carry out so much of the patient conversation, and the patient sort of human-to-human touch points, where the doctor in a way is an authority and the nurse sees this.

You know, show me a patient that would rather be stung by a needle than swallow a pill. I think there’s also some elements there where they really carry the bulk of the human interaction in a hospital. That it’s the nurse that greets you as a patient when you check in, and they show you to the room.

They visit you in the room if you’re in the hospital. So that’s a really cool insight, Nicole.

Lisa-Marie: And what I also think was part of the success was the promotion that you did, Nicole, on social media.

Nicole: Yeah, we made a movie with a big paracetamol tablet. It’s one metre.

It’s really a huge one. And we were showing it in a movie, and it was literally travelling through the hospital, and then we challenged other hospitals to join the challenge. And they can ask for the tablet, and this started three years ago, and the tablet is still moving from hospital to hospital.

Not only in the Netherlands, also in France. And also at Curaçao. Yeah, so this is a very nice way of, I think, engaging people, also with a big smile on their face. It’s a bit of fun. And if patients see the tablet, because sometimes we move it to a hospital from one site to another, they’re all smiling, and I get very nice questions.

“Oh, I have a headache. Can I try that tablet?” Or “Wow, that is a big one, ha ha ha,” makes sense. So people really see it, and I think that’s what’s really fun about this challenge.

Frederik: That’s super cool. That’s a lovely case for inspiration. When I was looking into the work you’ve already been doing, I stumbled upon something I’ve never heard of before, a proton pump inhibitor.

And since I had no clue what this is all about, I think it could be interesting to have a chat about that. So, without knowing if this is completely silly, so then you need to course-correct me with this. So if we were to pick the proton pump inhibitor, who gets it? Why do they get it?

And what is its journey throughout the system? Who decides that it’s given to somebody? And how is it supposed to be stopped being used or returned? And where does this stop date get lost?

Lisa-Marie: Yeah. So proton pump inhibitors are mainly being used as gastro protection. So they’re combined with other medical treatments.

If they are harsh on the stomach, then we could add a proton pump inhibitor to protect the stomach, literally.

Frederik: And what are we looking at here? Does it look like a food processor, or does it look like a pill? I’m completely in the dark here.

Lisa-Marie: No, it’s actually a pill. It’s a pill.

Frederik: Okay.

Lisa-Marie: It’s a pill, and it helps to reduce gastric acid, so it can also be used to reduce gastric acid complaints.

Frederik: Okay. So is it one you take every hour, a pill every hour, or a pill a day, or a pill a couple times a week?

Lisa-Marie: No, it’s one pill a day. One pill a day.

Frederik: Okay.

Lisa-Marie: And it can be prescribed by a gastroenterologist.

It can also be prescribed by a GP, but it can also be prescribed as part of a procedure. So for instance, because you get a pain medication, and certain types of pain medication, we often combine it with a proton pump inhibitor as gastro protection.

And there comes the tricky thing already, because you initiate it, maybe in the hospital, maybe at the GP’s office, but who is discontinuing it?

And actually, recent research in the Netherlands has shown that these proton pump inhibitors are being used so often. So I think two different proton pump inhibitors are in the top five most used medicines in the Netherlands, and I think it’s similar in Scandinavia. And then this research showed that in first-line care, 88% of these proton pump inhibitors are being used without an actual indication.

So about 90% of the patients who are using this in first-line care don’t have a reason for using these medicines anymore. Maybe they had at one point, maybe they didn’t. But I think that’s insane. Nine out of ten.

Frederik: That’s absolutely mind-boggling. Has this been adopted by the Choosing Wisely?

Lisa-Marie: Yeah, definitely. Proton pump inhibitors do get a lot of attention in international deprescribing guidelines, processes, also in our national guidelines. It does get some attention, more from a clinical point of view. But the thing is that the side effects are quite modest. So patients… yeah, it’s not really a burden using them.

And also what happens when you discontinue them all of a sudden, you could get rebound effect. So you could get, like, gastric acid complaints for a few days in a row, and then it’s really hard to stop them, because you think, “Oh, I need them,” and then you start using them. So there are some struggles with discontinuing them, but I think there’s also a big administrational problem, and that’s mainly who initiated the drug and who is then following it up. So for instance, if it’s initiated in the hospital, then the GP is following it up, but the GP didn’t start it in the first place, so maybe doesn’t feel like, I need to stop this. So I think there’s also a big behavioural component here.

Frederik: Wow. And this is, I suppose, a generic medicine. It’s no longer on patent?

Lisa-Marie: No, it’s definitely generic. In the Netherlands you have to pay for the first prescriptions yourself, so there are also some costs to patients. So that might be even an additional reason to stop it.

Frederik: Wow. I never heard about that case before. Thanks a lot for enlightening me, and also, I think maybe it’s the proton in there that gets me into sort of a Star Wars type of imagination realm where I’m imagining…

Nicole: But I think it’s good to mention the drug names also. People would recognise, I think. It’s omeprazole, esomeprazole, rabeprazole and pantoprazole. Those four are on the market.

Frederik: That makes sense. Thanks a lot, Nicole. So how could we change this?

Lisa-Marie: Yeah. So one of the interventions, actually two of the top-scored interventions, are focusing on these proton pump inhibitors, and not without a reason, as we just explained. So one is looking for patients who use these medicines without an actual indication, and then deprescribe them. And the other one is being more critical when to initiate these medicines, because like I just mentioned, we can use them as gastro protection to prevent symptoms.

However, that’s only needed in case of risk factors, and risk factors could, for instance, be using other medicines, could be your age, could be comorbidities. But what happens with the guidelines is that we just include them in our pain package regularly, so all the patients get them, even if they don’t have those risk factors.

So we could also be a little bit more hesitant with initiating them. So that’s the two things you can do.

Frederik: That makes a lot of sense. So in a way you can say changing guidelines is probably one of the sort of root causes that we would need to fiddle with to address this.

Lisa-Marie: Well, it’s okay in the guidelines, but in this case it’s the order sets we use in the hospitals where it goes wrong.

Frederik: Can you elaborate?

Lisa-Marie: Yeah, so we have these standard pain packages, so a physician doesn’t have to prescribe all the drugs separately. For instance, in case of a hip surgery, they can just use the package of medicines being commonly used for hip surgery. And then the proton pump inhibitor may be a part of that package already.

So then it is included for all the patients undergoing hip surgery.

Frederik: Makes sense. Yeah. So if we review those packages and figure out how can they be discontinued, then we might be able to address this. Now, I think something now, we were talking a lot about the bigger picture.

If we are to look at the bigger picture, the way I understand it, the carbon evidence on deprescription is still relatively thin. But maybe you can walk us through what is the reason for clinicians to change, and how do these new insights play into that? And what is motivating clinicians, and how are they going about it?

Nicole: Yeah, I think what’s really important here is that the carbon emissions of medications within hospitals are quite high. We have numbers that the CO2 emissions from medications account for 25 to 40% of the footprint of the so-called Scope 3 emissions. So Scope 3 is everything that we buy and use within hospitals.

So that’s really high. In the Netherlands, many doctors do have this information. So they really want to do something, and they feel they also often need to change their practice. And then it comes back to the question Lisa-Marie already mentioned, is how can I change? And what do I need to do?

So we’re really trying to provide guidance within this national programme to, yeah, to make life a little bit easier. Making sure that the patient is safe, but that the prescriber has all the information to change this, to stop something or to change the prescription anyway.

So as this is getting more and more attention, and if you look at it on a drug level, yeah, that’s right that often there’s a lack of data. There are some databases out there, but it’s not easy to make that estimation or calculation. So also there we try to help. So our programme has numbers on CO2 of the specific drugs that are in the programme.

So in the end, if an intervention is implemented, the hospital can do the calculations on their savings from a CO2 perspective.

Frederik: Is there any tools that you recommend hospitals to use for that?

Nicole: Yeah. That’s really Lisa-Marie’s expertise.

Lisa-Marie: Yeah, we try to develop tools in our own programme that are as easy as possible, because often physicians don’t want to be occupied with getting the data out of the systems, and I do get that.

They should focus on their patients. So we try to make it as easy as possible and develop tools that stick really closely to what you can extract easily from our systems. But that’s quite a challenge, and I’m working on that a lot. But I think, back to the study that we’re discussing, we didn’t have climate impacts, so that’s why we focused on appropriateness, because I do feel that appropriateness entails more than just the potential environmental impact that you could obtain from it.

It’s also about feasibility, because if you want to implement something that doesn’t work in practice, then no one is going to implement that successfully, and then you have zero impact at all. So for us, appropriateness was both sides of that medal, having an environmental impact but also being feasible in practice, and that’s why we asked our panel about appropriateness.

Frederik: Yeah, that makes perfect sense, and I think it’s also playing into a field where they already understand what’s going on, and you’re not alienating them by introducing something that’s not their wheelhouse subject, in a way where I think that’s a really nice move, to take it where they can also feel comfortable answering within their professional expertise.

Cool. Thanks a lot for sharing about this project and this topic. I really feel I learned a lot in this conversation already. So what I always ask our guests is, when we’re working in the realm of sustainability and healthcare, there’s a very dominant exposure to doom and gloom in the realm, and there’s a good reason for that.

But I think it’s also important for us to stay, if not optimistic, then at least hopeful. So, Nicole and Lisa-Marie, what gives you hope working with this subject?

Nicole: Yeah, I think more and more healthcare professionals feel that they can make impact. I think that really changed. A couple of years ago people felt bad about it.

Like, yeah, if I change something and make my practice more greener, it will not add to an effect in the end. But now this is changing. So more and more healthcare professionals feel that they can make impact by changing small things and sometimes also big things within their practice, and to make it more green.

So that really gives me hope, and it also, I think, shows that we’re doing the right thing at the moment.

Lisa-Marie: Yeah, for me I would like to share one really specific example. It’s not in hospital care, but it was actually a GP from the Netherlands who at one point decided to make a fake patient in the system.

And every time she would be tempted to prescribe but didn’t think it was really necessary for that patient, she just prescribed it to that fake patient in the system. So at the end of the year, she could then see all the prescriptions that she didn’t prescribe and weren’t needed in the end. And I think that is a great example of giving yourself a tool, a practical tool, to really work on deprescribing in practice, and also to make it fun and give you insights in the benefits.

And I think that comes back through this conversation and through our work. Environmental sustainability can be something that is really fun to work on, and it’s really nice to demonstrate what we can achieve if we work on this.

Frederik: That’s a super cool example. I really like that. If some of our listeners have their own practice, and I know there’s a bunch of practitioners out there that have their own practices, could they do something to adopt this?

Nicole: Oh, yes, of course. I think it’s good to mention our website, where all the examples are shown, and also together with an implementation plan. And I think also the example that Lisa-Marie just shared, like if you feel you want to prescribe but there’s no need, a fake patient, or maybe even a small database, can really help you out there.

And I think you can then follow your own steps, and that also motivates you.

Frederik: But it was not a concrete software product that was latching on, that counted the non-prescription cases? Did she do it by hand on the side? How was it practically carried out, Lisa-Marie? Do you know?

Lisa-Marie: Yeah. It was just in the GP system, to have a fake patient and prescribe all the prescriptions in there, so at the end of the year you can see the entire list which you prescribed to that specific fake patient.

Frederik: Ah, okay.

Lisa-Marie: So no extra software needed. And I think that is what inspires me, the creativity here.

Frederik: Yeah. That makes a lot of sense. So if that’s feasible in your system, then that’s the solution. You create my phantom patient that takes all the drugs I don’t prescribe, and then you count it after that. That makes a lot of sense.

Nicole: Yeah. You could even call it “my greenest patient”, maybe. As a name.

Frederik: That’s a really fun solution. Yeah, thanks a lot for sharing that. And thanks for coming on the show. I really, really appreciated you taking your time to enlighten us on this agenda and to share your insights with our listeners. So, if you’re keen on learning more about Nicole and Lisa-Marie’s work, they’re very easy to find on LinkedIn and also to look up online.

We’ll include a bunch of links in the show notes and also a more elaborate description and the title of the works that we’ve talked about in the conversation. So, thank you so much for listening. You have been listening to an episode of the Sustainable Healthcare Podcast, today on deprescription as a decarbonisation lever.

I’m your host Frederik Dam van Deurs, CEO in Care Pathway Consulting, and it has been a great pleasure hosting this episode. Remember to like and subscribe and share the show if you liked it. We’re trying to get as many people to listen to this, so these tactics and tools and strategies for decarbonisation of healthcare can be widely distributed.

And I really enjoy making these episodes. So, Nicole and Lisa-Marie, thanks a lot for coming.

Frederik: Thanks for chatting.

Lisa-Marie: Thanks for the invitation.

Frederik: Cheers.