Helping with the psychosocial needs of patients

The psychosocial needs of patients can feel overwhelming for a doctor.

Our rite of passage as medical students, after all, is anatomy, not sociology.  Even now, after a family medicine residency specializing in the biopsychosocial approach to medicine, I still brace myself for surprises before asking routine mental health screening questions of the patients in the community health center where I work on Chicago’s South Side.

“Have you been feeling down or depressed, any loss of pleasure in life in the last two weeks?” I ask all patients.  If they say yes, I can ask more questions to possibly diagnose depression, and offer them exercise, counseling or medications.  If they say no, then next question. Theoretically.

Frequently, however, a quick psychological screen reveals complex social needs.  A typical response goes, “I’m not depressed, doctor, but I am really stressed, my husband just lost his job and I can’t get food on the table for the kids”—or “yeah, I’m sad, my mom’s dying of cancer, and now my car’s broke down and I can’t get her to her doctor, I’m real worried about her.”

Thankfully, I don’t need to deal with complex psychosocial needs by myself.  I work with a team.  As the physician, I’m specialized to look after the biological needs.  A group of counselors serves the patients’ psychological needs.  And now a dedicated group of college volunteers helps the Chicago Family Health Center serve patients’ social needs.

The college volunteers are part of a national group, now called Health Leads, started in 1996 by a college sophomore at Harvard by the name of Rebecca Onie.  She partnered with Dr. Barry Zuckerman, Chief of Pediatrics at Boston Medical Center, to organize college volunteers to man information desks in the lobby of the hospital to link patients to the social services they needed in the community.  Project HEALTH, as it was then known, spread to hospitals and health centers in Providence and New York City, then Baltimore, Washington D.C., and Chicago.  As of August 2010, about thirty students from the University of Chicago began volunteering four hours each week at a Health Leads Family Help Desk at the Chicago Family Health Center’s South Chicago site.

I love being able to refer patients to Health Leads.  When I’m in clinic, and a patient reveals a life on the economic margins, teetering into illness, I have a simple tool to keep them from falling over the edge.

“Would you like to get a call from the Family Help Desk?” I’ll ask them, and explain the program.  For the woman with the loss of family income: “They can link you to food pantries, connect your husband with unemployment, help apply for Medicaid, help you apply for help paying for electricity, and connect you with job training programs.”

For the family with no car: “They can connect you with medical transportation services.”

For the illiterate grandmother wanting to learn to read so she can read with her grandchildren: “They can connect you with literacy programs.”

If the patient is amenable, I refer them to Health Leads, and the college volunteers take it from there.

With college volunteers looking after routine needs, our clinic’s sole social worker is able to focus on more psychologically demanding cases, such as domestic violence and substance abuse.

As a family physician, my role is to identify and respond to the most common health needs in the community, taking care of them on my own if I can, or referring the patients to specialists to care for their health problems if need be. When it comes to social needs, I don’t need to memorize all the community resources.  I just need to identify patients’ needs and refer them to Health Leads to be connected to the resources they need.  The Health Leads college volunteers are my social service specialists, partners in the quest to create a healthier America.

Kohar Jones is a family physician who blogs at Progress Notes.

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  • Mindy

    “Frequently, however, a quick psychological screen reveals complex social needs.”

    How good do you expect everyone’s life to be?

    ““Have you been feeling down or depressed, any loss of pleasure in life in the last two weeks?””

    Who hasn’t?

    • Kristin

      Whoa. Before you judge a diagnostic tool, try to understand the goal of its designers and the process by which it’s designed and implemented.

      The screening tools used for psychological purposes have typically been validated experimentally with large groups of people who have or do not have diagnoses of various mental illnesses. The questions are designed to differentiate between someone who’s functioning within normal parameters and someone who is not. The responses of a person who’s feeling a little down but is still functioning pretty well tend to be different, in predictable and measurable ways, from the responses of a person who’s so depressed that they’re unable to function.

      Psychologists would have to be raving morons to assume that everyone is perky all the time. That’s why there are multiple diagnostic criteria for mental illnesses: not just is the symptom present, but does it cause dysfunction–can the person still function in society? Does it cause distress, to the person in question or to their loved ones?

      So you start with a broad question like, “Have you been feeling down?” and if they say yes, you go through more questions to target what kind of down and how bad it is. Is it depression? Is that depression severe to the point of clinical significance? Is it obsessive-compulsive thinking? Are those thoughts severe enough that the person would benefit from treatment? The screening tools are designed to help funnel people who would benefit from clinical intervention toward a specialist. They’re not as precise as the in-depth inventories a psychologist or psychiatrist would use during an appointment; they’re not supposed to be.

      • Mindy

        “Have you been feeling down or depressed, any loss of pleasure in life in the last two weeks?” I ask all patients.

        All patients who are there for what?

  • Donna Guerrero

    This is where a good social worker on staff helps.. I think having a social worker as part of your team in office could help staff and patients with those things that DR aren’t as experienced in.. The good thing on my side is I have healthcare background and now pursuing my master in social work I understand both sides.. It take a team and we are all important.

  • Donna Guerrero

    I guess my comment didn’t post.. Social worker are trained in in these areas yes however we can do much more than just find resources .. Depending on the social worker we can counsel and provide skills to help with there situations also.. If I was a Dr I would hire me one on staff it could make you life easier no only with patients but with your staff.. Oh and pay them what there worth lol ..