A detailed social history is essential to the early identification of carbon dependence syndrome (CDS). Enquire specifically about the following tell-tale signs of a high carbon lifestyle:
Home energy use accounts for about one-quarter of carbon emissions for the average household, but excesses can be difficult to spot in the consultation room. If T-shirt findings are inconclusive, try asking whether your patient opens windows to cool down in winter.
This is a very common form for the Munchausen-by-proxy** variant of CDS: parents will often insist on taking their children by car for very short journeys, and may become defensive if questioned. Look out for excuses such as “it was raining” or “we were running late”.
Useful tip: ask about favourite vegetable foods – difficulty answering this question has very high correlation with chronic meat excess, which patients may not admit to at their first visit. It is important to pick this up, as diet also accounts for over one-quarter of household carbon emissions, and a family of four each eating a quarter-pounder beef burger account for similar carbon emissions as a return car trip from London to Cambridge***.
Recent progress in the field of CDS has seen the revival of Consumption as a medical term. In addition to the traditional symptoms of cough and fever, the newer variant is characterised by frequent purchasing of consumer goods. Be aware that the precise selection of products consumed varies widely with age, sex and social class. Asking about the number of remote controls in the patient’s household can give a useful guide.
* It is important to exclude thyroid problems in T-shirt positive patients.
** Munchausen-by-proxy entails injury to a dependent person by his or her carer to gain medical attention. (Oxford Handbook of Clinical Medicine 5th Ed., 2001)
*** Quote from IPPC Chair, Dr Rajendra Pachauri, speaking in London on 8 Sep 2008.