Physicians could arguably play a role in efforts to mitigate and adapt to the health effects of global environmental change. This paper presents an initial qualitative exploration of United States physicians’ perspectives with regard to whether, why and how physicians might discuss the health effects of global environmental change, climate change in particular, with their patients and what would need to change in healthcare systems to facilitate this. Interviews were conducted with eighteen physicians working across the US and representing different medical specialties. Data were analyzed using conventional content analysis. We found that most physicians felt such conversations should become part of clinical encounters, primarily to help patients protect their health. However, it was also highlighted that physicians might have objections, referring to the risk of creating feelings of fear or powerlessness and of undermining the physician-patient relationship. This study highlighted that such conversations therefore need to be relevant and actionable, for which timing and communication style are essential. Major barriers for such conversations include a lack of knowledge, conversation skills and guidance, lack of time, and physicians’ perspectives on their role in realizing good quality care. Building on these explorative findings, our tentative conclusion is that discussing the health effects of global environmental change during clinical encounters can become part of physicians’ roles, but that this requires competence development and fundamental changes in the operation of healthcare systems. Future (quantitative) studies are necessary to further understand how such discussions could take place and be facilitated in different settings.