Social determinants of health. As a physician, am I asking the right questions? I recently went to a conference given by Aaron Dieringer MD who is also a Masters in Public Health candidate. He showcased the ways that I can be aware of environmental differences in patient’s lives. These issues need to be addressed differently than I have been doing before.
Examples of issues that are biased// juxtaposed to more appropriate questions…
- “Do not take this medication on an empty stomach.” //What if the patient does not have access to food regularly (or even daily)?
- “Go outside to walk every day for exercise.” //Do you have a safe nearby area to walk?
- “Come back in the office in 4 weeks.” //Is there a time or date that works best for your next appointment to help with transportation issues?
- “See the specialist that I am sending you to.” //If you are unable to get to the specialist’s office due to transportation issues (not on a bus route) let the social worker in my office know and we will work with you to get this fixed.
How to help?
- Consider immediate postpartum placement of long-acting reversible contraception. 50% of pregnancies are unintended. The risks unintended pregnancies are that the patient may not be taking a prenatal vitamin or may be using alcohol or drugs.
- Centering pregnancy. This is a group prenatal visit. The first few minutes are one-on-one with a physician and then the rest of the hour is a group learning session about a pregnancy issue. This form of prenatal visits has decreased the disparity in pregnancy outcomes. https://www.centeringhealthcare.org/what-we-do/centering-pregnancy
- Student Outreach Clinic. The University of Nevada Reno has a free medical clinic available to the local underserved population. One patient example given was a woman seen for asthma exacerbation who needs steroids to avoid worsening in her condition, necessitating an ER visit or a hospitalization. One question to ask of all patients is “If I prescribe you medication on the $4 Wal-Mart list, can you afford this?” Some patients cannot afford this and there are social work workarounds… Up to 60% of preventable mortality is attributable to social and economic circumstances. Want to know more about our UNR SOC? med.unr.edu/soc/clinics
- Project Upstream is a program which accompanies the UNR Student Outreach Clinic. These Project Upstream volunteers help address the social determinants of health that may affect their treatment (transportation, $4 medications) so that the physician’s advice has a better chance to be adhered to with more optimal care outcomes.
I hope this helps.