Why communications with patients should be considered a social determinant of health

“You know, doctor, I can’t afford a $ 15 drug. ”

A young grandmother was sitting in front of me. She had several problems, including obesity and high blood pressure. She was making about $ 670 a month, most of which went towards her rent. All that was left had to pay for everything else: food, medicine, trips to the doctor – and she wanted to be able to buy birthday presents for her grandchildren.

I suggested that she start taking extra blood pressure medication.

“Do you want me to come see you for my dates?” Or do you want me to take this new medicine? She asked me. “I can’t afford both the bus to your office and the new drugs. ”

“What am I supposed to do?” she asked anxiously.

I wanted her to be able to do all of these things: take all of her meds, keep her doctor’s appointments, and buy birthday gifts for her grandchildren. She needed a new care plan.

This story stuck with me for a long time. This event did occur before the social determinants of health became an important part of our discussion of national health policies, but social determinants have had an impact on outcomes since the first surgeries in ancient times.

As physicians, we are trained to take a patient’s education, cultural background and income level into account when providing treatment and care. We tailor our approach based on our understanding of the patient environment.

But when we talk about addressing social determinants, one thing is often overlooked – communication – as well as how we engage with our patients in the modern age.

Our ability to communicate effectively directly affects a patient’s access and quality of care. Extensive research has shown the benefits of effective communication about patient health outcomes.

But over 70% of health outcomes are due to factors other than health care. For example, one study found that 5.8 million people in the United States delayed medical care because they did not have access to transportation. And an estimated one-third of adults with chronic illnesses underuse their prescription drugs due to cost concerns. Yet they fail to share this information with their physician, an obvious gap in patient-provider communications.

If we don’t know how to reach and engage patients outside of the doctor’s office, in a way that fits both their lived experiences and their cultural background, then we can’t provide the care they need and that they deserve.

Our strategy for communicating with patients should reflect our state of mind when we are in the examination room: adaptive based on our understanding of the whole patient.

Many patients cannot wait on the phone for half an hour or more, or be available during traditional office hours. They work double shifts; they work at night; they are family caregivers. An email filled with medical terms, jargon, or even English may not make sense. The traditional one-size-fits-all approach to patient communications doesn’t work (and if we’re being honest, it never really worked).

Today we need to communicate with patients the same way we communicate with family and friends, taking into account a range of factors such as work hours and preferred language.

This could be an after-hours email, a series of text messages sent throughout the day, or a scheduled video conference. We might even end up using a combination of communication channels, schedules and languages ​​to meet the range of patient needs. With 97% of Americans owning a cell phone, we have the tools to meet the vast majority of patients where they are.

It is only when we tailor our approach to each patient and truly engage them beyond the exam room, in ways that suit their lifestyles and experiences, that we will be able to meet the needs of patients between sessions. visits and filling gaps in care.

Additionally, every point of patient contact, whether billing or clinical in nature, can play a role in deepening our understanding of the patient. Providers who recognize this, and synthesize the often disparate communication touchpoints, will thrive in patient-centered care.

As for the grandmother on a tight budget? We were able to reduce the number of medications she needed and found cheaper alternatives so that she could go to her check-ups and pay for her prescriptions. And she bought these birthday presents.

About Thomas Brown

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