Medical training teaches us to look at patients beyond their vital signs and laboratory data.
Who are they as people? What are their struggles in life? What social determinants of health contribute to their well-being? A patient encounter during my second year of medical school left me wondering: How can physicians with busy schedules tackle social factors that are not directly in the patient nor the physician’s control?
The patient that comes to mind was seeking medical care at an infectious disease clinic in a large underserved city population. He was HIV positive and experiencing homelessness, with job prospects limited by a distant history of incarceration. He qualified for free medical care from yearly department of health grants that helped him receive the HIV medication that kept his viral load under control. This was conditional on him keeping appointments on a strict three-month schedule, which was not easy without money for bus fare. Closing an interview with him one day, I asked if there was anything else I could do for him. Teary-eyed and with a broken voice he said, “It feels like every time I pass on the baton in the relay race of my life, after really pushing through to complete my part, the next person I hand the baton to drops it.”
He was referring to getting his life back together: including finding affordable housing and a new job. The lack of momentum after many months of trying left him depressed and grieving. It was in that moment that I started to question whether a physician could really treat a patient holistically without tackling the social concerns that weigh patients down. Yet, to address these concerns would require effort beyond the four walls of an office visit and a time commitment not feasible with routine 30-minute visits.
Once in residency, I came to the realization that as physicians, we are not alone when it comes to providing optimal care for our patients. Rather, we must be open to the help and skills of our non-physician colleagues to provide more complete care for our patients. In the outpatient setting, this help has come in the form of complex care coordinators or nurses who ensure patients with complicated medical issues are not lost to follow up; pharmacists who ensure patients can afford the vital medications they need; and social workers who quite literally help patients navigate the health care realm by arranging transport to and from appointments and ordering much-needed mobility devices for the elderly, ensuring health equity through access.
In the modern Hippocratic Oath taken by all newly-minted physicians, we swear, “I will remember that I do not treat a fever chart, a cancerous growth but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.”
I hope we realize that the debt of fulfilling this responsibility is not ours to bear solely. Yet, it is our responsibility to identify obstacles to care and to pass on the baton to the right individual until our patients are cared for more holistically. Ideally, passing on the baton entails providing appropriate referrals to our nursing, social work, or pharmacy colleagues to follow up with patients prior to the time of their next visit. Open and continuous communication should be an integral part of the process until a shared end-goal is achieved, ensuring that the baton is not dropped by any single individual. Most importantly, remembering to include the patient in the on-going discourse is key, so that they too feel that we are not just “treating a fever chart” but a complete human being.
How have non-physician clinicians helped you with your patient care? Share your stories of collaboration in the comments.
A native New Yorker, Dr. Babar is passionate about classic literature, studying novel advancements in medical therapy, and helping younger generations foster a shared curiosity for all things science. Dr. Babar is a 2021–2022 Doximity Op-Med Fellow.
Illustration by Diana Connolly