Why knowing patients' stories can help family physicians avoid care pitfalls

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Family physicians can avoid life-threatening consequences of missed diagnoses and treatment opportunities by working to ask patients about their social challenges, argues Gary LeRoy, MD, American Academy of Family Physicians board of directors member, in an AAFP blog post.

"Each day as family physicians, we have the unique privilege of interacting with an audience of patients seeking to engage in a professional dialogue regarding their health and wellness," Dr. LeRoy wrote. "Each patient arrives at our exam room with a 'situation' other than their obvious chief medical complaint."

Dr. LeRoy said these situations can often be presented as "Oh, by the way" comments. "Even the most skilled physician can misinterpret the reality of the patient's situation if the physician does not have a critical mass of unspoken facts about the patient's life," he wrote.

A physician's unintentional misinterpretation of a patient's reality can have life-threatening consequences, potentially leading to a missed diagnosis, a delay in necessary intervention, overutilization of diagnostic medical resources, increased morbidity or premature death, Dr. LeRoy noted.

"Our prime duty, as physicians, is to 'do no harm,'" Dr. LeRoy wrote. "We set the groundwork for this early in the physician-patient relationship by acquiring the patient's vital life facts along with their vital signs."

Although the thought of taking face time to obtain additional more facts about a patient's life situation can be daunting for physicians, it is a worthwhile investment if it prevents these harmful consequences of not understanding patients' situations, Dr. LeRoy argues.

In January, the AAFP launched the first component in The EveryONE Project toolkit through its Center for Diversity and Health Equity to assist AAFP members in collecting crucial background data regarding patients' social determinants of health.

The screening tool is offered as a short (11 questions) or long (15 questions) survey and documents a patient's status regarding housing, food, transportation, utilities, child care, employment, education, finances and personal safety.

"Every patient brings certain social determinants of health into the office with them at each visit," Dr. LeRoy wrote. "However, certain minority populations may bring a disproportionate burden of unspoken social challenges. It is essential that these SDOHs be recognized and appropriately addressed within the context of a patient's comprehensive wellness plan."

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