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Tuesday Apr 03, 2018

Knowing Patient's Story Improves Odds of Happy Ending

From I Love Lucy to Modern Family, each generation of television viewers has had a favorite situation comedy. At the core of most sitcoms is a common plot formula: A familiar cast of characters is introduced to a situation at the beginning of every episode, and the viewer watches one or more of them misinterpret it. This is followed by a sequence of comedic errors of judgment and antics intended to keep viewers laughing for 30 minutes. By using commonplace situations familiar to the audience, writers of the most enduringly successful sitcoms weave a subtle moral take-home message into each script.

[finger pointing to social determinants of health]

Each day as family physicians, we have the unique privilege of interacting with an audience of patients seeking to engage in a professional dialogue regarding their health and wellness. If we were to draw a comparison to the plot formula mentioned above, we would deduce that each patient arrives at our exam room with a "situation" other than their obvious chief medical complaint. I classify this as the "Oh, by the way" comment. Even the most skilled physician can misinterpret the reality of the patient's situation if the physician does not have a critical mass of unspoken facts about the patient's life. An unintended misinterpretation of the patient's reality can lead to a missed diagnosis, a delay in needed intervention, overutilization of diagnostic medical resources, a treatment misadventure, increased morbidity or premature death.

Misinterpretations of reality make good plot lines for sitcoms, but in medicine, the consequences can be life-threatening. Our prime duty, as physicians, is to "do no harm." We set the groundwork for this early in the physician-patient relationship by acquiring the patient's vital life facts along with their vital signs. Admittedly, the thought of consuming precious face time obtaining more facts about a patient's life situation is daunting, but it is a worthwhile investment if it prevents the proverbial comedy of errors from arising out of what we did not know.

To assist our members in the collection of vital background data regarding a patient's social determinants of health (SDOH) the AAFP launched the first component in The EveryONE Project toolkit through its Center for Diversity and Health Equity in January. This paper and web-based screening tool can easily be incorporated into physicians' intake procedures to help them identify and respond to key social determinants that adversely impact a patient's health outcomes. The screening tool is offered as a short (11 questions) or long (15 questions) survey that is available in English and Spanish. It documents a patient's status regarding housing, food, transportation, utilities, child care, employment, education, finances and personal safety.

The AAFP created the screening tool in response to a resolution submitted to the 2016 Congress of Delegates. The EveryOne Project online toolkit will continue to mature as the capability of developing partnerships with local social and behavioral health referral resources evolves.

Every patient brings certain social determinants of health into the office with them at each visit. However, certain minority populations may bring a disproportionate burden of unspoken social challenges. It is essential that these SDOHs be recognized and appropriately addressed within the context of a patient's comprehensive wellness plan.

Health disparities have been well documented -- but unchanged -- for too long. In 1985, HHS released a landmark report of the Task Force on Black and Minority Health, known as the Heckler Report,(www.cms.gov) which highlighted the health status of Asians/Pacific Islanders, blacks, Hispanics and Native Americans. (Then) HHS Secretary Margaret Heckler noted that the report "signaled a sad and significant fact; there was a continuous disparity in the burden of death and illness" in our country's minority populations.

The Heckler Report launched a national discussion about the root cause of health disparities among racial and ethnic minority populations in the United States. This resulted in the establishment of the HHS Office of Minority Health in 1986 and the eventual designation of April as National Minority Health Month.(minorityhealth.hhs.gov) That makes this month a prime opportunity to align with state and local health departments to increase awareness of the health disparities that impact racial and ethnic minority populations.

In our AAFP Member Value Statement, we cite our commitment to help family physicians improve the health of Americans by providing solutions to enhance patient care. The tagline of The EveryONE Project is "advancing health equity in every community."

Advancing health equity makes our communities more vibrant places to live and enhances our capability to ensure patient well-being. Accurately understanding the situation from which our patients arrive at our office is no laughing matter because every life and EveryONE matters.

Oh, by the way, that's the moral of this story.

Gary LeRoy, M.D., is a member of the AAFP Board of Directors.

Posted at 01:24PM Apr 03, 2018 by Gary LeRoy, M.D.

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