Why is Screening for Social Determinants Difficult?

By | October 16, 2019

In the present age of healthcare, we understand that social determinants play a critical role in health and wellness, as well as influencing our ability to treat illnesses. Those who identify with issues such as food insecurity, intimate partner violence, availability or quality of housing, and the ability to pay for necessities such as utilities like heat and water, area also more likely to struggle with psychological issues such as depression.

We have several tools we can utilize to screen for these, though our usage of them is presently minimal or non-existent. Why are we having such a difficult time?

Undoubtedly, one factor is the separation of public health, social services and medical care. There is nominal coordination or even understanding of what resources are present in the communities we serve. Simultaneously, as physicians, our training does not focus on such issues, so caregivers are less inclined to have such conversations with patients. Furthermore, there is a bombardment on offices with activities concerning “medical” care, which does not seem to leave enough time to delve into these social determinants. Hence, disallowing  us to care for “the whole person!” Also, there is a great concern that patients will be uncomfortable discussing such matters.

If we are going to do right by those we serve, we should ignore these barriers because understanding social factors is necessary for us to care for our patients. Regardless of the visit type, there is the procurement of temperature and weight. Why? Do they affect all situations? Of course not. Social determinants of health do. Having a list of local community services can satisfy the argument of a lack of resources. Open communication concerning issues that are central to those we serve will only enhance our relationships and thus improve our ability to diagnose and treat.

It is unnecessary for the screening to be completed by the physician. With technology, we can reverently ask the appropriate questions in multiple different ways and in numerous locations. The leading excuse I receive is, “Why screen for something I can’t fix?” This logic is flawed on multiple levels. First, how do I even know that a problem exists unless I ask? Second, how do I create care models without knowing the extent of the situation at hand? Lastly, why do I not wish to intervene when I know social determinants are so critical for health and wellbeing? Is it better for us to avoid the situation or, must we address our own biases?

Since, undeniably, health professionals are knowledgeable and serve others, let us solve these basic needs of those we are so honored to serve. Let us overcome our barriers, delve into the psychosocial axis of human frailty, and become holistic in our approaches.  If resources are scarce, let us solve the scarcity, not avoid the problem. If time is of the essence, let us distribute the tasks. At the heart of the matter is accepting the concept that without solving the social determinant needs, we will fall woefully short in our vocation of healing those in need.