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    How physicians can overcome socioeconomic obstacles to improve adherence


    Long’s clinic uses a seven-page intake form that not only covers the standard medical questions, but details about the patient’s life. Questions about substance abuse, employment, insurance style of learning, goals of care and incarceration are all asked to gain a complete picture of the person’s life and the challenges he or she faces.

    Bhatt says that physicians can start with screening questions that take the form of, “Do you have trouble getting here?”, “What kind of neighborhood do you live in?” and “Are you having difficulty getting food for yourself or your family?” 

    “Though these questions are personal, they can help physicians build relationships with their patients and give them insight to better understand factors affecting their health,” Bhatt says. Many professional organizations offer screening tools and guidelines, so that’s a good place to start.


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    Gail Cunningham, MD, FACEP, chief medical officer for University of Maryland St. Joseph Medical Center, oversees a program aimed at reducing the hospital’s readmission rates for patients struggling with psycho-social issues that affect their health. The hospital uses a nurse practitioner to interview patients about the nonmedical challenges in their lives and helps direct them to community resources and nonprofits that can help.

    “Some patients are honest and some are a bit delusional about reality,” she says. “Some patients are fiercely independent and don’t want help or don’t think they need help. Some may decline our service then get home and realize [dealing with their social issues is] harder than they thought and will call us back.”


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    While it can be challenging to get a full picture of the patient’s social challenges, experts agree that the more commitment physicians show toward the patient’s well-being, the more they are willing to open up. But Bryce says to be careful not to stereotype, especially about income.

    “Social determinants are not always just about income level,” he says. “If you are not getting the results you want, it’s important for the physician to look deeper at the care model and the patient and why they are not getting better. Sometimes when you dig deep, that’s when you’ll find an answer in the challenges the patient faces.”


    Providing solutions 

    Treating patients with challenges that affect their adherence can be frustrating, but it starts with taking the right attitude. When a patient has been told multiple times to eat healthily and make sure they are taking their meds only to return having done none of it, the first response from a doctor might be
    exasperation. But Bryce says it’s better to pause and focus on empathy. 

    “We don’t necessarily understand the life they live,” says Bryce. “If you try to understand it, it will allow you to better take care of the patient and decrease the pressure you put on yourself if you are not getting the results that you want.”

    Todd Shryock
    Todd Shryock, contributing author


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