Unmet social needs worsen health

Physicians are frustrated by social issues that affect their patients' health -- so much so, that nearly three of four doctors surveyed by the Robert Wood Johnson Foundation said they would write a prescription to cure them if they could.

Eighty-five percent of primary care physicians and pediatricians say unmet social needs are directly leading to worse health for all Americans, according to the survey, which was released online Dec. 8, 2011.

Yet, only 20% of doctors feel confident or very confident in their ability to address those needs.

Unmet social needs could be any issue that is not under a doctor's direct control, and may or may not be under the patient's control. Many physicians say they want to prescribe nutritional food, exercise housing assistance and help with utility bills in an effort to improve their patients' health.

For the Robert Wood Johnson Foundation survey, 1,000 primary care physicians and pediatricians were polled by Harris Interactive between Sept. 16 and Oct. 13, 2011.

The survey found that 82% of physicians said patients frequently express health concerns caused by unmet social needs that are beyond their control as physicians. And 74% of doctors report that these unmet needs often prevent them from providing quality medical care. These unmet needs were reported as affecting patients of all income levels.

"This should not be a big surprise. ... Primary care physicians aren't trained to address these issues," said Jane Lowe, PhD, a senior program officer at the foundation. She also is team director for the foundation's Vulnerable Populations Portfolio, which works to improve people's health by addressing their social needs.

Lowe added that physicians' limited time during office visits increases the challenge of resolving these matters.

More than four in five doctors wish they were able to spend more time with their patients, but they say the current health care system makes that nearly impossible.

For example, a common challenge among doctors is getting children's asthma under control, Lowe said. The problem often stems back to the youth's living situation, which can include mold growing in their residence and insecticides sprayed outside to control bugs.

The issue is "not that physicians aren't doing a great job. But there are social factors that are impeding" their ability to control the condition, Lowe said.

Social factors that doctors said have the most negative impact on their patients' health include a lack of education about how to make healthy decisions and a lack of motivation to follow through with the needed lifestyle changes, as well as inadequate access to mental health services and low household income, the survey shows.

What physicians can do

An estimated 60% of premature deaths in the United States are attributed to social circumstances, environmental exposure and behavior, according to the Robert Wood Johnson Foundation's report on the survey findings.

To help physicians better address patients' social needs, the Robert Wood Johnson Foundation said changes need to be made within the health care system. Such changes include covering the costs associated with connecting patients to the appropriate social services.

Lowe encourages physicians to educate policymakers in their communities and states about the connection between social factors and health.

There are steps that physicians can take to help patients address their social needs, said Saul J. Weiner, MD, senior associate dean for educational affairs at the University of Illinois at Chicago.

He encourages primary care doctors to talk to all of their patients about barriers that might be keeping them from leading a healthier life and to determine whether there is anything they can do to help remedy the problem.

Having such conversations does not extend the office visit, according to Dr. Weiner's study of 399 unannounced visits to 111 internists in Chicago and Milwaukee, published in the July 20, 2010, Annals of Internal Medicine. In the study, actors portrayed patients and followed scripts that contained hints of clinically significant biomedical issues, such as an asthma patient wheezing at night.

"The mistake is to think that social issues are never things physicians can help patients with," said Dr. Weiner, also an associate professor of medicine and pediatrics at the University of Illinois at Chicago.

"Sometimes physicians can't do anything about [a person's unmet social needs], but sometimes they can. The only way for doctors to find out if they can help is to ask patients" what is going on, he said.

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