SDH Friday Refelction

[Omeralfaroug Adam]

Social determinants of health are a concept that has been recently introduced to me. Even though I have always known about the importance of these social factors and their influence on my patients’ health, I have always had in mind their effect on non-communicable diseases like diabetes and hypertension.

This clinic week I had a patient with history of diabetes, hypertension and depression. Since that she is already following with a psychiatrist and I was seeing the patient at a mental health clinic, I thought that the main focus of today’s visit was going to be on managing her diabetes and hypertension. In the midst of the history taking process I paused for a second and I started asking the patient about how things are going at home. The Patient started crying and then started telling me about how she is going through a major life crisis, as she is going to be separated from her son and soon she will be evicted from her house and become homeless. At that moment I did not care about that LDL of 130 or that A1c of 10, the focus of the visit has changed to helping this patient walk through her crisis.

I realized that it doesn’t matter how much cognitive behavioral therapy this patient goes through, doesn’t matter how many antidepressants this patient is taking and it doesn’t matter how much I educate this patient about Diabetes and hyperlipidemia. Her medical and mental health issues will never be managed appropriately if we do not address her social issues!!

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