The Hidden Value of a Patient"s Social History
The "Good Old Days" of Paper Charts
Cynics and neo-techno luddites will forever lament the loss of the elegance and availability of the written word, particularly when it comes to the paper medical chart. There are some things to be said for this position. But, to be fair, there have been opportunities that were missed or not taken advantage of in both the eras of the written chart and the electronic health record (EHR).
In particular, the social history section has long been misunderstood and underutilized. No, I"m not going to enter into the old axiomatic debate of whether substance use belongs in the medical history or social history. Instead, I"m speaking of taking full advantage of the "social" aspect of the social history.
Throughout my more than 20-year career, I"ve used the social history to keep track of notes that help personalize my relationship with patients and provide them with good service. I"m talking about such things as weddings, births, anniversaries, recent vacations, and anything else that might be important or represent a milestone in a patient"s life.
Thankfully, I"ve been able to maintain my methods with our current office system. However, between the "usability"/ease of interface of some EHR systems, and the ever-increasing time pressures that the system and its documentation requirements exert, the social history is becoming more of an anticlimactic social history. But I digress.
Providing good service should be a priority for all physicians. Patients, of course, hope to receive good service. Old and well-cited studies have shown that patients can"t always accurately judge the quality of the care that they receive. However, they can recognize personalized service, be it froma hotel, a restaurant, or a physician"s office. They also often equate personalization of care with quality of care.
What You Gain by Taking a Good Social History
It has become de rigueur to note the usual details in the social history. However, because this is the only appropriate area of the chart to log other nonmedical details, recording other information can quickly help each provider, or even nonclinical staff, to provide more personalized care. Being able to easily retrieve such details as the name of a beloved pet, or asking about grandkids who are in college, can garner quick and ready positive attention.
This approach can also be of benefit in those cases of "same name" conflicts. For instance, remembering by a glance which John Smith has a particular interest, or even a hobby that he shares with you, can be very helpful. As physicians, we take care of thousands of patients. Recording these details can help you keep things straight, even when you"re tired, behind schedule, or preoccupied trying to figure out a complex medical problem.
Remembering to throw in a question about a family member or remembering the destination of an anniversary trip are the sorts of details that all physicians hope to recall when engaging in personalized care with their patients. Systematizing this approach is a provider"s only hope in today"s fast-paced medical climate. The social history is the best place to store them, because most EHRs allow for free-text entry in this area, if no other. Unfortunately, these machines often make it difficult to enter such information, bringing our profession one step closer to treating patients like they, too, are machines.
The Reason We Entered Medicine in the First Place
Taking the time and making the effort to really get to know patients isn"t merely a series of one-way interactions. Spending 30 seconds broaching personal topics can preserve the one type of enjoyment for which we all entered the profession in the first place.
If these interactions don"t come easily to you, I suggest you read Olivia Fox Cabane"s The Charisma Myth: How Anyone Can Master the Art and Science of Personal Magnetism (Portfolio/Penguin, 2012). This book can help you examine your own capabilities in interacting with patients and help you address any insecurities you might have.
The freedom to make personal connections with our patients is the reason why physicians sought out healthcare rather than finance, IT, or some other high-paying (or higher-paying) profession. This degree of personalization also helps to balance the social interactions between physicians and patients, who have come to share and discuss elements of their lives that perhaps no one else may even know about. Chatting with them about nonmedical topics—even if it"s for just a minute—helps patients understand that they"re empathized with as a whole person, not just as a list of problems or an organ system.
Although I make a concerted effort to collect the details of my patients" lives, I"ve never been accused of doing this on purpose. Even if you do get "caught" referring to your notes, what patient could object to you and your staff making the time and effort to take such an interest? In some cases, especially when you"re scrambling to stay on schedule, attending to such discussion points also helps patients feel you spent more time with them than you actually did.
In short, the physician who includes a brief social interaction during the office visit is judged by patients to have taken more time with them and to have delivered better care. Properly motivated, caring, personal interactions like the ones I"ve described—in medicine and in our lives in general—facilitate the lubrication upon which a civilized society functions.