Unfortunately, I have a prior engagement that prevents my participation in a TEDMED Hangout tomorrow. The topic is important: why do we not discuss socioeconomic and other social factors routinely when we know that these items influence health? As the website states:
We’ve all experienced a doctor visit. The physician measures your blood pressure, pulse, breathing, and temperature. They may ask about personal or family history of specific diseases or even inquire about eating or exercise habits. Rarely, however, do they ask about your income or education, access to healthy foods, the safety of your home, or the stability of your personal life. And yet, we know that 40 percent of one’s health is shaped by socioeconomic factors, and only 20 percent by clinical care.
The site implies that these factors could be another vital sign. I would not put them in that category (just as I would not have made pain a vital sign), but I do agree that we don’t think about these things enough. After all, how can my patients follow my advice when
- The neighborhood may not be safe for outdoor activity that would help the child with weight control
- The family can only get to a convenience store; if they pay for transportation to a grocer, they have no food money
- The parent and patient cannot understand the instructions, even after discussion in clinic and reading the written stuff the electronic medical record prints out (meaningful use can be so meaningless)
- The parent moves the family frequently because of an abusive ex, making support services difficult to maintain
As physicians, our training allows only the most superficial assessment of these issues. We need specialists in these social issues, people known as social workers! However, in the current reimbursement climate, these services often get cut.
In a time when economic pressures force us to see patients in less and less time, we need to recognize the need for multidisciplinary more than ever. I hope that events like this one can get the conversation going. I also hope that the role of crushing poverty in bad health gets more attention.
One way or another, we all end up paying for these inequalities.