Tips for Addressing Social Determinants of Health in the Exam Room

Michelle S. Quiogue, MD


June 28, 2019

Editorial Collaboration

Medscape &

This transcript has been edited for clarity.

I'm Dr Michelle Quiogue, a family physician in Bakersfield, California, with the Kaiser Permanente Kern County Medical Center, and I am speaking with you as part of a collaboration with the American Academy of Family Physicians (AAFP) and Medscape. I am a health equity fellow for AAFP, and this is my view on social determinants of health (SDoH).

The specialty of family medicine has always been about addressing SDoH. We have been taught, since residency, about the model of biopsychosocial medicine. A medical student even told me that he decided to specialize in family medicine because it's the specialty of context—the context of an organ in the whole person, and the person in their whole family, and the person in their whole life. It's really a privilege to be a family doctor, and maybe other specialties can adopt some of those models of thinking and caring for patients in order to address SDoH.

It can feel overwhelming when you think about doing upstream interventions to address SDoH. It really is out of an individual physician's hands, for example, in terms of deconstructing structural racism or addressing income inequality and poverty. Those are huge social problems that one person may not feel empowered to address. Yet, in our individual exam rooms, we're able to make a difference for each patient by addressing the context of their lives.

Practical Tips

There are two practical tips that I can share as a family doctor to help address SDoH in the exam room. First, be practical about it, and in doing so, you will undermine the stigma of asking for help. I think many patients don't want to be viewed as the kind of person who needs help. A lot of patients don't want to ask for resources that they're eligible to receive. So often, every single day in fact, patients tell me they can't afford their copays, they can't travel to see the specialist. My community has resources to help patients to be able to afford their medications, to have discounted copays, and to get rides to their appointments. Therefore, it's helpful as a physician to tell patients, "That's just a practical problem. Let me help you with that. It's not out of scope. You shouldn't be ashamed or embarrassed. It's part of caring for you." I think that's helpful for patients—to not feel stigmatized that they need to access community resources. To reiterate, the first tip would be to normalize connecting to social resources.

The second tip is to be a team player. Healthcare is a team sport, and even as the family physician, you are not expected to carry the entire load. Make sure that your workflow is shared, that your burden is shared, and remember that healthcare is a team sport in your offices.

Finally, I want to say that family physicians are addressing SDoH, and they probably aren't giving themselves enough credit for that. Not only are they doing so in their exam rooms, but family physicians are also addressing these issues in boardrooms and as executives. They are running for office. They are entrepreneurs. Therefore, it's a good time to be a family physician.

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