Addressing Social Hardships in Patient Care
It’s no secret that social determinants of health can play a role in patients’ quality of life and long-term health outcomes. But it can be easy for physicians to get caught up in providing care and miss opportunities to have a larger impact on health by addressing the social hardships patients may face.
Elizabeth Wilson, MD, a pediatric neurologist at Cincinnati Children’s and director of the Multiple Sclerosis and Neuroimmunology Center, wants physicians to know they can do more than they think. She’s dedicated her research to describing the prevalence of social determinants of health and how they affect outcomes—especially in patients with rare neuroimmune disorders like multiple sclerosis—as well as ways physicians can use their role to effect change.
Steps Physicians Can Take
Providers like to think that the medical system and medications improve patient health, and they do, Wilson says, adding, “But when you look at how much traditional medical care impacts health outcomes, it’s very small. It’s somewhere around 10%. Nonclinical factors impact the other 80%-90%. So social factors are certainly something that can impact health at a large level.”
Approaching the issue of social determinants can be one of the most frustrating parts of being a physician, Wilson says: “The challenges can feel so far above your ability to do something.”
The first step is simply acknowledging that differences exist and that not everyone is going through the healthcare system with the same experience. The second is having a conversation with patients. Sometimes, that’s just building a survey into your intake forms that asks patients about any social hardships they face, so you can help connect them with resources if they need them.
“Most commonly, patients are dealing with housing insecurity and food insecurity, but there are other hardships they can face, too, like trouble getting to and from appointments or lack of childcare options,” Wilson says.
You also can make yourself aware of resources that are already available—both within the hospital and within the local community—to help your patients. You may be able to partner with care managers and local social workers, for instance, to bring work that’s already being done elsewhere into the neurology space.
“It seems that almost all large institutions now have some kind of working group within the hospital that focuses on addressing these issues,” Wilson says.
Physicians can request a meeting with their state representative and share stories of patients they’re treating who have complex medical conditions. Highlighting how the patients’ social hardships have affected their health may help bring about changes, like legislation requiring landlords to provide air conditioning in cases where there’s a medical necessity.
“We can use our role as physicians to help our patients get access to some of these basic needs,” Wilson says. “Sharing an individual patient story with your legislator can be really powerful.”
A Long-Term Plan for Long-Term Health
Wilson sees her work as two-pronged: To improve the day-to-day lives of patients and also their long-term health outcomes.
Patients with rare neuroimmune disorders like multiple sclerosis who struggle with social hardships tend to have worse outcomes, she says, like more active disease and more emergency room visits. Wilson’s research has also found that children with multiple sclerosis who face a social hardship like food insecurity develop symptoms and are diagnosed at a younger age than other patients.
“It’s a really interesting and important point to acknowledge that the disease itself might be acting differently just based on the patient’s environment and exposure to chronic stress,” she says.
Wilson hopes to next turn her attention to this area—looking at how the environment is affecting disease progression at a biologic level.
“It’s two ongoing processes,” she says. “We need to understand this interaction at a cellular level, but also have measurable actions we can take now to help patients in real time.”
(Published October 2024)
