Issue link: https://beckershealthcare.uberflip.com/i/1475102
22 PATIENT & CAREGIVER EXPERIENCE A powerful way to start a medical appointment? With non-medical questions By Erica Carbajal T alking to patients about the social determinants of their health is just as, if not more, important as prescribing medication to treat an ailment, according to physicians practicing at organizations that utilize screenings to learn about factors like housing and employment. Patients, especially young ones, want their providers to ask such questions. A poll led by researchers at the University of Michigan in Ann Arbor found 81 percent of Gen Z respondents said it's important for medical teams to ask about food, housing, educa- tion, safety and discrimination. "We have an iPad that patients utilize during the check-in process for primary care visits," said Jay-Sheree Allen, MD, a family medicine specialist with Rochester, Minn.- based Mayo Clinic. "On this iPad there are questions asking about the different areas that fall under the broad category of social determinants of health — things like social connections, tobacco use, depression, physical activity, transportation needs, employment status, financial resources, food insecurity, intimate partner violence, hous- ing stability," Dr. Allen told Becker's. Within each of the broader categories are specific questions. Under housing stability, for example, Mayo Clinic asks, "In the last 12 months, was there a time when you were not able to pay the mortgage or rent on time?" Many of the U-M survey respondents said they simply want to hear their providers' general advice regarding social determi- nants of health, underlining the power of listening — something that's oen forgotten in medical care today, Tammy Chang, MD, a family medicine physician at U-M Health who led the poll, told Becker's. "People think, 'We have to do something. We have to write a prescription.' But part of it is just being a supportive person … part of that is listening," she said. For health systems considering introducing such screenings but hesitant to ask patients to complete yet another form, both physi- cians said the pros trump the cons of the additional ask. "Don't be deterred by the fact that you are adding more work for the patient, because when you do pick up on something, it is worth that effort," Dr. Allen said, adding the screenings can open the door to conversa- tions about topics patients may not even real- ize they can talk about with their providers. "It's not intuitive that every patient feels they can talk to their doctor about their housing. You don't just put 'doctor' and 'housing' together. You don't necessarily put 'I have no food' and 'my doctor' together," Dr. Allen said. "It's important for patients to know that we are a resource for these factors that very clearly impact their health outcomes, even though it's not the most publicized portion of medicine." When a social determinants of health survey is completed, physicians can begin the conversation with patients by simply telling them they reviewed their responses and ask patients to tell them more about any concerns raised. "I usually say something like, 'It looks like you filled out this survey. Let's go over it. It looks like you need help with housing, tell me more about that,'" Dr. Chang said. From there, patients are connected with social workers and other allied staff who Physician viewpoint: The fading presence of family at the bedside By Molly Gamble D aniela Lamas, MD, a pulmonary and critical care physician at Brigham and Women's Hospital in Boston, has noticed a big difference in her hospital and in patient care since the pandemic began: "an erosion of the family presence that we once embraced." Dr. Lamas wrote about the shift in a New York Times op-ed June 14. Although her hospital has returned to normal in many ways — no more talk of canceling elective surger- ies, the return of the cafeteria salad bar — she poses the question of whether this return to normal is as good as it gets, and whether the promises she made to herself about caring for patients post-pandemic will be realized. "In the ICU, we still have visitor restrictions. Families can ar- rive, two people at a time, at 11 in the morning and leave at 8 in the evening," Dr. Lamas wrote. "This means that they are rarely a part of rounds, or present at the bedside late into the night. Though these rules are intended to avoid the spread of the virus, I suspect they have lingered despite falling rates of [COVID-19] transmission because we have grown used to hospital life without visitors." She also notes that physicians who are now completing residency gained most of their experience "in a world without robust family presence," caring for patients who were intubated and under sedation, behind closed doors, donning masks and managing fear of virus transmission. "To think that a possible [COVID-19] exposure would not cause panic is itself a sign of great progress. But at the same time, we are so far from where we thought we might be by now," Dr. Lamas wrote. n