Integrating Social Determinants into Redesigned Care


Teaching Medical Students about the Social Determinants of Health Improves Patient Care

When a patient comes seeking care, typically providers identify symptoms, diagnose, treat, and send the patient on their way with a care plan. But what happens when the patient returns presenting the provider with the exact same issue from the first visit? Are these patients treated exactly the same way again and simply deemed noncompliant?

Today, many teaching hospitals and medical schools are advocating a different approach. They are training residents and medical students on the social determinants of health. Instead of following the traditional model where physicians focus on the presenting illness, diagnosis, and treatment, they are asking these new physicians to identify the social circumstances or behavioral health conditions that are at the root of health issues.

The change comes as the healthcare industry aims to improve health outcomes and reduce the cost of care. With the emphasis now on preventative care, providers need to bridge the gap between community health and healthcare.

At Boston Medical Center, the largest safety-net hospital in New England, Dr. Thea James, the hospital's vice president of mission and associate chief medical officer, has made education on health disparities a priority. After seeing patients return to the Emergency Room multiple times despite proper care, he created training programs for staff, including intensive workshops for new residents, to learn how to better identify social determinants of health and care for these individuals.

"We can always, more often than not, fix … whatever brings you here," James says, "But if we send you back to what caused it, without ever finding out what caused it, we are just fueling that cycle."

Boston Medical Center is among one of the many hospitals throughout the country that are emphasizing a change in how care is delivered. John Hopkins established an initiative called “Medicine for the Greater Good” in 2013 providing a formal 12-week educational series that teaches residents about health disparities. Since it began, 82 residents have taken part in nearly 300 projects to benefit Baltimore residents.

Changes to Medical Curriculum Address Social Factors in Healthcare

Across the country, medical schools are changing their curriculum to integrate medicine with public health. The University of Wisconsin School of Medicine added Public Health to its name in 2005 signifying the importance of this issue and recently celebrated a decade since the milestone. Rather than establishing a whole separate curriculum, they began incorporating public health concepts into the required medical school courses. For instance, in studying the anatomy, physiology, and pathology of the lung, the lessons also included topics such as approaches to smoking cessation and the role of the environment on asthma. 

More educational programs need to follow suit. As healthcare transitions to focus on population health, healthcare professionals must break away from the traditional model of care. Today’s providers need to ask more, getting to the root of the issue, to truly improve health outcomes.

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Topics: healthcare delivery social determinants of health

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