As a physician, I was taught to diagnose and treat. Sure, I knew your social situation outside of my office played a role in your overall wellbeing, but it really was not in my differential diagnosis. Undeniably, I did what I could to help with those situations, but only within the context of increasing the ability of the patient to comply with my treatment regimen.
In recent years we have become much more aware that these social determinants of health (SDOH) have a big impact on one’s health. As a result, we invest more of our time and our staff to address such issues, but what is the physician’s actual role? Who truly owns these social issues, where are they best addressed, and by whom? Many of the issues patients are dealing with are so far upstream from this visit; what can I really do at this point? And if I focus on these matters, will it lessen my impact on the physiologic issue at hand?
At the core, physicians’ engagement with SDOH is different than providing healthcare. As stated earlier, we are aware of their impact, and yet, we view our role as providing care for an immediate need, or a chronic medical situation. However, we have been asked to take a bigger role and act as coordinators of measures of which we are not trained, nor do we have the resources at hand to impact a solution.
All that said, we still cannot abdicate our responsibilities for total care of those we serve by hiding behind the veneer of “We are just here to care for you when you need us.” As a profession, we concentrate on providing health and wellbeing. In this vein, there are many opportunities for us to make an impact by taking a more holistic approach. At our core, we are teachers. We train not only the next generation of physicians but also all those that we encounter. So, we can use this to educate our patients the same way we would those we train. And although we may not intervene, maintaining SDOH at the forefront of our minds and discussing at every turn will only enhance everyone’s understanding of their importance.
A more diverse physician population may also ensure that SDOH is always top of mind given the diversity of experiences and background of the caregiver. After all, we are all “formed” by our life experiences and cultural upbringing. Most importantly, physicians are a trusted and respected voice on health care matters. Let us use that voice within the context of medical care and focus our attention on SDOH. We can point to our patients’ narratives and their journeys, connecting them to our ability to fully affect their health in an optimal manner. We can be the voice of those we serve in a much more powerful way. We have the ability to advocate on their behalf through a lens that is not presently represented. We must expand our thinking concerning what it means to diagnose and treat. Though we may not be able to “cure” at the point of care, our “treatments” have power beyond our present contemplation if we harness our voice and focus.