Are the social determinants of health (SDoH) just a “feel good” trend?

Christina Farr (@chrissyfarr) recently published a piece that addressed the “elephant in the room” at healthcare conferences – which is “there is very little recognition of the human cost” as it pertains to the lack of interoperability, broken processes and heavy regulation in the healthcare industry.

While Christina’s article addresses the disastrous byproducts of the lack of interoperability, for instance, I’m preaching the same message, but about the social determinants of health (SDoH): “we’re going to have to focus on what it means to be a patient. And think about how we can do better before it’s too late”.

This article is part 6 in a series studying the clinician-patient relationship where I maintain the following: the conversations not happening between clinicians and patients are putting patients at a higher risk for serious medical errors like misdiagnoses, prescribing the wrong treatment plan or prescription drug, for instance.

The conversations I’m referencing contain the type of information that relate to a patient’s personal preferences and involve aspects of their health and well-being that do not necessarily involve physical pain and symptoms (e.g. socioeconomic status, education level, home environment, social context, values, beliefs, etc.) – you know, the SDoH that seem to be trending in healthcare discussions.

If the SDoH are real and relevant in healthcare, and we can agree it’s harmful when the SDoH aren’t factored into clinician-patient conversations, then why aren’t investments being made to address this issue?

In the past few months, I have had discussions with 8-10 highly regarded U.S. health systems, many of those being academic institutions in thought leadership positions, and I was shocked to learned how little investment, if any, is being put towards advancing the patient’s SDoH agenda. I’m talking basic education and training for administrators and clinicians, not costly digital health investments!

So, let’s discuss…

Do patients think clinicians can deliver care that meets their individual needs?

In a recent study, I surveyed patients from both the U.S. and U.K. in an effort to understand:

  • Are SDoH questions being asked by clinicians?

Approximately 50% of patients surveyed said a clinician never asks for details (the SDoH previously defined) about themselves and roughly 46% of patients stated some of the time

Nearly 49% of patients surveyed said they do not believe a clinician considers their SDoH when they make a diagnosis or tell them what they should do to treat a condition. Roughly 32% said they are undecided

  • Do patients perceive that the clinician wants to learn about their SDoH?

Only 23% of patients stated they believe a clinician wants to learn more about them as an individual (the SDoH previously defined)

  • Do patients perceive that the clinician understands them?

62% of patients were either undecided or disagreed when asked the question: “Do you believe a clinician understands your individual needs as a patient?”

Are the social determinants of health (SDoH) just a trend?

I want to believe the SDoH aren’t just a trend, but the jury’s still out! Despite the discouraging findings from the previously mentioned research study, I believe this problem is absolutely solvable, but it’s critical to understand: this will take time; this will take investment; and both clinicians and patients must have a vested interest in working together. Here are a few takeaways:

  • The current system is a hindrance to incorporating the patient’s SDoH

Misaligned system and clinician level financial incentives, clinician burnout, unrealistic ~15 minute office visits, desperately needed cultural change, broken processes, lack/misuse of technology, and the list goes on…

  • Education and awareness first

Despite plenty of evidence about health disparities and the lack of health equity in the current system, especially for marginalized communities, administrators and clinicians need to first understand the magnitude of the problem and then learn how to approach solving the problem before real change can take place. We need to do away with the notion that the clinician-patient relationship is somehow intuitive because it’s not!

  • Show me the money…humans…and time!

Human, financial and temporal investments shouldn’t be optional

 

Agree? Disagree? Tell me what you think!

 

LinkedIn: linkedin.com/in/laurenchofmann and Twitter:@LaurenCHof

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