Are physicians addressing the root causes of health problems?

While in residency, I took care of a toddler who was hospitalized following an anaphylactic reaction.  During a diaper change at home the child suddenly developed lip swelling and severe difficulty breathing for no apparent reason. The child was urgently brought to the hospital by ambulance and initially treated in the emergency room. By the time I met her on the inpatient floor her breathing and swelling had significantly improved. The first thing I noticed, however, was the child’s bumpy and irritated red skin which was covered with a thick layer of ointment. While I examined her she would claw and scratch at her skin with little relief. She looked miserable. Her mother had been suspecting food allergies and described a frustrating process of selective food avoidance and various skin treatments with little to no improvement.

Keeping in mind that eczema and allergic reactions are in the same family of disease, it was not surprising that this child was more prone to anaphylaxis. While her symptoms improved and she was sent home, the trigger for the severe reaction remained a mystery.

About 6 months later I ran into the child’s mother in clinic. The mystery behind the life threatening illness made this child memorable so I asked how her daughter was doing. Mom was happy to share that her daughter had not had any further allergic reactions and that the skin problems had nearly resolved.

So how did they cure her disease?

They moved.

After countless visits to specialists and various drugs that were not addressing the primary cause of her problems, one day the parents opened an infrequently used closet in their home.  Inside they found the closet saturated with mold.  Shortly after moving to a new mold-free home the child’s eczema immediately began to improve.

Its estimated that 70% of the factors that influence health are environmental and behavioral. It seems fairly obvious that food, access to transportation, and housing can affect health. But the health care system, and physicians specifically, are ill-prepared to address these social determinants of disease.

A survey of 1,000 American physicians conducted for the Robert Wood Johnson Foundation released recently showed that doctors know how important social factors are to health but feel unprepared to address them. 85% of surveyed physicians said that unmet social needs directly led to worse health. The same percentage of physicians said that a patient’s social needs are “as important to address” as medical problems. Of concern, 80% were not confident in their capacity to address their patients’ social needs even though it would improve the patient’s health.

Interestingly, if prescriptions could be written to treat social needs the way they could be used to treat illnesses, social prescriptions would represent one of every seven prescriptions the surveyed physicians would write.  The top social needs physicians said they would write prescriptions for included:

  • Fitness programs
  • Nutritional food
  • Transportation assistance
  • Housing assistance
  • Employment assistance

So what is to be done?

Are health care providers really addressing the root causes of health problems? How much incorrect treatment or unnecessary diagnostic testing occurs because these factors are not considered? Perhaps my patient could have been spared the the anaphylactic reaction had mold been investigated as a possible cause of her eczema.

How can health care professionals better address the circumstances in which we live, work, and play?

How can we structure the health care system to reimburse health care providers for addressing the behavioral and social factors that cause 80% of disease?

Ricky Y. Choi is a pediatrician who blogs at SFGate and reprinted with the author’s permission.

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  • Gregory A. Buford

    Nice article and definitely underscores what is missing in current medical care – the ability to actually treat patients and say what they need to hear.  As with many things in society, medicine has become diluted down so much that many physicians feel they cannot actually tell their patients that they are too fat, smoke too much, and are making all of the wrong decisions.  And to provide good care, that is exactly what they need to hear. 

    Although we obviously need to be sensitive to our patients, we also need to tell them the truth.  And when the truth is hard to hear, so be it.  If it means the matter between good or not so good healthcare, then the truth needs to be revealed and never candy coated. 

    Thanks for your insights!

  • Matthew Laing

    Insightful comments about social need impacting health. There is no reason not to reward health care professionals for addressing behavioural and social factors… we NEED to move away from a tertiary care system. Maybe rewarding health care professionals for percentage of patients who do not develop diseases??
    However as a side note, if physicians want to refer to dieticians for nutritional counseling, or physical therapists for fitness and conditioning- why don’t they?

  • Maharaja Sivasubramanian

    Really nice written article, going for the cause. Infact my definition of health and case taking procedure takes a comprehensive look abut health in such a manner as prescribed in accordance with preventive medicine. I make it a point to give home visit or client’s office visit in cases where I feel the environment may play a vital role and which The patient may be unaware of as having health implications.

    Be Healthier and Happier. Become Empowered and Enriched.
    Dr Maharaja SivaSubramanian N 

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