A powerful way to start a medical appointment? With non-medical questions

Talking to patients about the social determinants of their health is just as, if not more, important as prescribing medication to treat an ailment, according to physicians practicing at organizations that utilize screenings to learn about factors like housing and employment. 

Patients, especially young ones, want their providers to ask such questions. A recent poll led by researchers at the University of Michigan in Ann Arbor found 81 percent of Gen Z respondents said it's important for medical teams to ask about food, housing, education, safety and discrimination. 

"We have an iPad that patients utilize during the check-in process for primary care visits," said Jay-Sheree Allen, MD, a family medicine specialist with Rochester, Minn.-based Mayo Clinic. "On this iPad there are questions asking about the different areas that fall under the broad category of social determinants of health — things like social connections, tobacco use, depression, physical activity, transportation needs, employment status, financial resources, food insecurity, intimate partner violence, housing stability," Dr. Allen told Becker's

Within each of the broader categories are specific questions. Under housing stability, for example, Mayo Clinic asks, "In the last 12 months, was there a time when you were not able to pay the mortgage or rent on time?" 

Many of the U-M survey respondents said they simply want to hear their providers' general advice regarding social determinants of health, underlining the power of listening — something that's often forgotten in medical care today, Tammy Chang, MD, a family medicine physician at U-M Health who led the poll, told Becker's

"People think, 'We have to do something. We have to write a prescription.' But part of it is just being a supportive person … part of that is listening," she said. 

For health systems considering introducing such screenings but hesitant to ask patients to complete yet another form, both physicians said the pros trump the cons of the additional ask. 

"Don't be deterred by the fact that you are adding more work for the patient, because when you do pick up on something, it is worth that effort," Dr. Allen said, adding the screenings can open the door to conversations about topics patients may not even realize they can talk about with their providers. 

"It's not intuitive that every patient feels they can talk to their doctor about their housing. You don't just put 'doctor' and 'housing' together. You don't necessarily put 'I have no food' and 'my doctor' together," Dr. Allen said. "It's important for patients to know that we are a resource for these factors that very clearly impact their health outcomes, even though it's not the most publicized portion of medicine." 

When a social determinants of health survey is completed, physicians can begin the conversation with patients by simply telling them they reviewed their responses and ask patients to tell them more about any concerns raised. 

"I usually say something like, 'It looks like you filled out this survey. Let's go over it. It looks like you need help with housing, tell me more about that,'" Dr. Chang said. 

From there, patients are connected with social workers and other allied staff who can connect them to resources, like food pantries and other social services. Without the screenings, these health needs might go undiscussed, which could render the patient's visit less effective overall. 

"If a patient is having a difficult time with their housing or with their food — such basic needs in life — it doesn't matter what you want to address in their healthcare. Most of it is going to go over their head because their basic needs aren't met," Dr. Allen said. 

Patients realize healthcare providers alone can't directly solve some of these issues, but they may not know how well connected their care teams are to community resources. Screenings at least provide a starting point.

"It takes almost nothing for me to make a couple phone calls or to make one call to my social worker, who can then make a couple calls on behalf of my patient. Honestly, that may do so much more for their health than the prescription that we so desperately think that they need," Dr. Allen said. 

The extra upfront effort helps get ahead of worsening healthcare conditions in the future, benefiting patients and providers. 

"If we can help to optimize those environments in partnership with patients, then we can hopefully get at some of the more root causes instead of waiting until the end of the line to try to treat a disease," said Dr. Chang. "[Providers] may be surprised that just a short conversation about it can help them be a better doctor or provider." 

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