“Any alcohol use? Any tobacco use? Any other drugs?”
These are the three main questions that most health care providers ask their patients when documenting a social history on a note.
“What stressors do you have in your life? What social support do you have? What is your home life like? What do you do for fun? Do you wear a helmet when you ride a bike? Do you wear a seatbelt?”
I remember learning these questions and having to ask them to a standardized patient as a medical student. My classmates and I laughed about how silly some of these questions seemed. How does wearing a helmet have anything to do with my patient’s pneumonia? Why do I care about what my patient does for fun when they’re having a medical emergency?
A recent patient encounter I had showed me that sometimes a more thorough social history can help me to better understand my patient. I had a patient who I was admitting from the emergency department with a chief complaint of shortness of breath and chest pain. I only had a few minutes to review her prior notes before seeing her. There was one thing I noticed in the social history, however, that helped me better understand my patient. This was not only mentioned in her primary care provider’s notes, but in the various subspecialty physician notes as well.
“The patient is the primary caregiver to her husband, who has dementia.”
This statement primed my brain. As I reviewed the patient’s medications with her, she told me she had not been taking several of her prescribed medications over the past week. From reviewing her prior notes, this seemed a bit unusual as she typically was very compliant with her medications. As I asked her some more questions, I learned that her husband had just passed away. She had been busy being a caregiver to her husband, and also had to deal with the funeral preparations. Even after her husband’s death, my patient had an amazing caregiver mentality:
“I’m just glad all of this happened now and not when everything had been going on over the past couple of weeks.”
My patient recovered and was discharged home to her very supportive family. I felt confident that she would have proper follow-up and social support, as her family had been in the hospital with her and was very involved in her care. At the end of her hospitalization, it was amazing to see how much stronger she was than when she first came in.
The social history was very helpful in this situation and can be applied to almost any patient. Social factors can be a major hindrance for patients to be healthy. In this example, my patient had excellent social support from her family. Despite even the best support, caregivers still get overwhelmed and can put their loved one’s health needs in front of their own. It’s important to tell our patients who are caregivers that they need to be extra cognizant about taking care of themselves. An ill caregiver is not going to be as helpful as a well caregiver.
Taking this a step further, it is even more overwhelming for caregivers if they do not have social support. If they are the only ones caring for their loved one, it can be an extremely daunting task. Perhaps one of the most unavoidable social history issues is financial stress. Caregivers may try to save money by not going to see their own doctor. They may avoid taking their medications or refilling their own prescriptions to save money.
Health care providers don’t have time to ask all the social history questions with every patient. The social history, however, provides us with a small window into the lives of our patients. Our patients are more than their diseases. It’s easy for providers (myself included) to get frustrated when people don’t listen to our recommendations. By looking at the big picture, we can better understand the daily lives of our patients. If our patients feel that their health care providers are trying to better understand their day to day lives, they may be more inclined to work as a team with their providers to ensure they live as healthy lives as possible.
David Goldberg is an internal medicine intern who blogs at Help Me End Alzheimer’s.
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