Viewpoint: The benefits of the social history

August 6, 2010

The author believes that because he has taken the time to learn more about his patients, the medical care he has provided to them has been better. He has had a relationship with them, not just an encounter.

And just last week I was called for another nursing home admission by a hospitalist who reported "90-year-old guy with Alzheimer's who is falling too much in the adult family home and needs more care." When I saw his name on the chart, it sounded familiar. I Googled him to confirm that he had for many years been a star columnist for the local newspaper, a well-known TV and radio personality, and local celeb. I had a copy of one of his books.

And over the years, I have met soldiers wounded at the Battle of the Bulge, teachers from one-room country schoolhouses, builders of the Golden Gate Bridge, African missionaries, professional ballplayers, and so many people with rich and exciting lives, now reduced to being "the gallbladder in bed 12" or "the stroke in 214."

But there's more. I believe that because I have taken the time to learn more about them, the medical care I have provided to them has been better. We have had a relationship, not an encounter. I have taken care of them, not their illnesses.

Those with good cognition have enjoyed sharing their stories with me, and for those with cognitive loss, their families have enjoyed reminiscing with me. When they saw I cared about them as people, it gave them a sense of trust in me they previously did not have.

It's important that we not get so busy "taking care of stuff"' that we lose the opportunity of "taking care of people." It concerns me that some of our colleagues may be so be focused on getting the job done, the records finished, and the case closed that they may not realize that what they see in front of them is not a diagnosis or an ICD-9 code but an actual person, one whose brief time as a patient is only a tiny portion of what was a long and meaningful life.

I am also concerned that because we set the standard, other healthcare workers may mimic this type of physician behavior by focusing only on the job at hand and not more holistically on the person facing them.

So take just a little more time and obtain a good social history. It will give confidence to your patient and his or her family, set a good example for the patient's other caregivers, improve the care you provide, and maybe even bring a smile to your face and some joy to an otherwise stressful day.

I always ask people where they went to high school and what the school mascot was. "When I was there," said 88-year-old Claire, "it was me!"

Have an interesting story to share about your patients' social histories? Send your feedback to medec@advanstar.com
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