The final word: Whole patient care maximizes health outcomes

Wednesday, January 01, 2014 11:42 AM

Christopher Fellenz, MD
Kaiser Permanente Community Benefit Program

To be effective physicians, we must base our patients’ care on the evidence of medical science. However, there is also an art to healing patients – one that requires creativity and empathy. It is exceedingly fulfilling to see patients achieve better health because we’ve accurately diagnosed their condition and prescribed an effective treatment plan that they have successfully followed. Unfortunately, a few patients will remain in poor health despite our best interventions. Typically categorized as “noncompliant” or “difficult,” these patients require a second, deeper look to understand what interfering life circumstances may be affecting their ability to access health care or follow a treatment plan. Research shows that when providers approach these patients’ care with empathy and a more complete understanding of their lives better clinical outcomes are achieved.

These interfering life circumstances, also known as social determinants of health, include factors such as a patient’s income, education, access to quality food and housing, race or ethnicity, and many others. Many Coloradans face significant barriers to getting their health care needs met. Patients may face issues accessing care without insurance, filling prescriptions they cannot afford, finding stable transportation to get them to and from appointments on time, or communicating in their non-native language. Noncompliant behaviors – such as not taking a prescribed medication or scheduling a follow-up visit – may be the result of limited resources or understanding. We can be more successful providers if we recognize each patient’s unique challenges and work to address their needs in a way that is appropriate for their situation.

Additional research shows a troubling trend affecting our future colleagues – medical students experience a marked decline in empathy as they enter their third year of school. Empathy requires a focused time and presence that can be difficult to balance with the already extensive demands on a clinician’s time and attention. It can be especially challenging for students and new clinicians to strike this balance, but it is critical for our patients’ health. In an attempt to address this issue, the Colorado Coalition for the Medically Underserved (CCMU) has produced an educational video that demonstrates how some social determinants interfere with health care treatment (www.ccmu.org/sdoh). I consulted on and participated in the video, and am excited to share it with my colleagues of today and tomorrow. In addition to the video, there is a discussion guide aimed at stimulating conversation around common-sense and creative solutions for approaching whole patient care. It is CCMU’s goal to incorporate the video into the curriculum of our state medical schools and other health professional training programs.

Our society at large must work to minimize the effects of these social determinants of health, as it is far outside the scope of an individual provider’s abilities. We will need changes at the federal, state, local and community levels to make health care accessible to all Coloradans. However, physicians do have a responsibility in this work. We must challenge ourselves to look beyond our patients’ symptoms to see the whole of their complicated lives. We must practice empathy and think creatively. Better clinical outcomes mean happier, healthier patients, and that’s ultimately what patients, providers and all Coloradans strive to achieve.

Dr. Fellenz serves as a family physician at Kaiser Permanente in Westminster, Colo., and is the physician consultant for Kaiser Permanente’s Community Benefit Program.