Social Determinant

[Anita Choudhary]

32 year old healthy women came to our clinic 5 weeks ago to establish care. Her medical history was significant for substance abuse disorder since teenage years, high risk sexual behavior with history of multiple STI in the past. Her concern on the day of clinic visit was pregnancy as she missed her periods. Urine pregnancy test in clinic was positive. She became anxious after knowing the test result and wanted to help herself in changing her behavior so that she can give best care to her kid.

I spent quite a time with her in the clinic, she agreed to join rehab and make significant changes in her behavior. She came to clinic this week and I was delighted to find that she did join rehab. She looked more happier and sober.

Sometimes, we underestimate our patients, what they are capable of. They do want to take care of their health but sometimes they need family support, their PCP guidance and a motivation. I will continue motivating my patients to help them to make health-enhancing changes. I happened to read a study reported in Annals of family medicine which identifies five promising strategies that may influence patients to make good changes for their health. Some of these strategies include, partnering with patients; identifying small steps to improve health and showing care and concern.

[walid m ibrahim]

A point learned from the social determination this week, as doctors, we should not limit ourselves to diseases and to think about the patient beyond the clinic boundaries. In fact, this as important as the Medicine in treating patients.

Today I have seen 70 years old pleasant women with uncontrolled Diabetes on Lantus for years; her diabetes is being managed by an endocrinologist.
I was surprised to see her HbA1c as high as 13, and her saying “ There is no way that I am going to the diabetes clinic no more.”
Me: Why? It seems that he is doing a good job, he prescribed Victoza, and Mixed insulin as well.
Have you been taken your medicines as prescribed?
The patients: He never listened to me!! I keep saying my insurance will not cover that medication and I am getting the Lantus as a free sample from the clinic.

Her social determinants of health is more important than her medicine which has never got.

I have learned that exploring the social history is as essential as prescribing the correct medicines. We are treating a human with complex aspects, not Diabetes or Hypertension.

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