The Social Determinants of Health — Moving Beyond Screen-and-Refer to Intervention

The article suggests that to improve our medical system, individual doctors must include the management of social determinants in patient encounters. I think this might be ideal but, where will they get the time when already stretched by patient obligations? I also wonder if that will have any immediate impact on the health outcomes of chronically ill patients of color. Some of whom need more direct intervention for acute and chronic problems. If I were a young person going into medicine, this phenomenon would drive me very quickly into specialty medicine.

Handling social determinants is a societal problem. My preference is that we build effective resources around physicians and leave the management of social determinants to the health plan or the institution.

List of authors.

  • Rahul Vanjani, M.D., 
  • Neha Reddy, M.P.H., 
  • Nicole Giron, M.S., 
  • Eric Bai, B.S., 
  • Sarah Martino, M.P.A., 
  • Megan Smith, M.S.W., 
  • Suzanne Harrington-Steppen, J.D., 
  • and M. Catherine Trimbur, M.D.

N Engl J Med 2023; 389:569-573
DOI: 10.1056/NEJMms2211450

Social determinants of health are certainly important contributing to how well patients handle chronic disease. Physicians can play a crucial role in addressing various aspects related to social determinants of health during patient visits rather than referring them to a middleman. 

Why is This Important: It seems to me there are several problems. Doctors barely have time to see patients now. If you throw in the requirement to organize the management of social determinant solutions, where will that time come from? Will this additional responsibility, keep doctors from going into clinical medicine?  In addition just because you start the process, that does not mean these social determinants like housing, food insecurity or aspects of mental healthcare will be easy to solve. It’s not like more traditional approaches to treatment.

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