A doctor diagnoses your mother with heart disease. She can no longer drive and you know she needs help with transportation to her medical appointments. You ask for advice—and get a blank stare. Or you are dismissed.
A growing body evidence shows that social supports may improve the overall well-being of people with medical conditions, especially chronic illness (here and here). A fascinating new survey shows that while physicians generally agree that assistance with housing, transportation, and nutrition is important to the health of their patients, most doctors feel they are not responsible for helping them get these services.
While the survey, by the consulting firm Leavitt Partners, was not focused specifically on the needs of older patients, many of the social supports it identified are critical to frail seniors and their family caregivers. And the results confirm what I’ve heard for years—from patients, care managers, and doctors themselves: Physicians feel they do not have the time, knowledge, or interest to guide their patients to important non-medical assistance.
The survey results are striking. For example, two-thirds of the doctors who responded felt their patients would be better off if they had access to transportation their medical appointments. Yet, only one percent of physicians felt they were responsible for helping their patients get those rides. Just three percent felt their staff was responsible while 89 percent felt that neither they nor their patient’s insurer had any responsibility for helping arrange transportation.
Important, but for others to do
The pattern was almost exactly the same when it came to helping their patients get sufficient food: One percent of docs felt it was their responsibility, four percent felt their office was responsible, and 84 percent said it was neither their job nor the insurance company’s.
Same story with information about affordable housing or local water quality. Even when asked whether they felt responsible for providing their patients information about the price of care, only six percent of docs felt it was their job. About 40 percent did agree that their offices should provide this information.
The study looked at a range of non-medical issues that have become known as social determinants of health. The evidence is growing that healthy behaviors, safe and appropriate housing, accessible transportation, and sufficient income are important predictors of people’s health.
And there are many reasons why physicians could play a key role helping their patients access these supports: Doctors are trusted advisors, they are in a position to know about their patient’s social needs, and they could serve as a critical entry point into the support system. And the potential benefits are high: Better outcomes for patients such as fewer emergency room visits and hospital stays, a higher likelihood of being able to remain at home rather than have to move to a care facility, and—possibly—some cost savings to the health care system.
Yet, as the survey shows, doctors are extremely reluctant to take on this role. The question is: What can be done about it?
One solution is to pay doctors to provide this information. Value-based purchasing models, where physicians are rewarded for patient outcomes and cost savings, are a way to do that. If these services can save they overall system money, why shouldn’t the docs who participate share some of the savings?
Not the best resource
But physicians may never be the best resource for information about housing or transportation services. When they say they lack expertise and interest, they are right. This is especially true of specialists but increasingly it is an issue for primary care doctors.
A few larger multi-specialty practices hire in-house social workers or nurses to play this role. Smaller practices could contract with care managers or care consultants. Such assistance already is available for older adults (once called geriatric care managers, their trade group now, sadly, calls itself The Aging Life Care Association).
One primary care doctor who makes house calls says that two-thirds of the care she was providing was, in fact, social work. So, she hired a social worker. It works for her patients and is cost effective for her practice.
The Leavitt study suggests that employers could take the lead in pulling together medical and non-medical services, and points to GEs HealthyCities initiative. I have written in the past about the role of faith communities in linking congregants to medical and non-medical services. Community-based non-profits and operators of subsidized housing also can play a key role.
The Leavitt study does continue one kernel of optimism. It finds that younger (or at least less experienced) doctors are more likely than older colleagues to believe that help with social supports would assist their patients. However, the survey does not say whether the younger docs are more likely to provide the assistance.
This survey has some limitations. The sample was small and the respondents not necessarily representative of all US docs. But the results confirm what is apparent. And they identify an enormous opportunity to fill a gap between medical treatment and the social supports that can enhance that care.