The most recent webinar features SCAN Health CEO, Dr. Sachin Jain, and it focuses on social determinants of health. These determinants, like poverty, racism, pollution, and access, impact a patient’s ability to receive care and comply with their care. They can also impact one’s risk for certain conditions, whether they may be caused by vitamin deficiencies or exposure to mold or unclean drinking water.
“We’re painting big societal problems of SDOH”
In Dr. Jain’s experience, many healthcare organizations claim to center the social determinants of health, but in actuality, they provide a “false sense of security and accomplishment.” He expresses that the issues run deeper in society, often relating to poverty and racism.
While being on the panel for Robert Wood Johnson Foundation, Dr. Jain reviewed the data to discover that very few interventions actually help in the long run. When looking at the population overall, there was very little effect on large groups.
He explains, “We make ourselves feel better. We’re introducing, medical rides program for poor people, and therefore, we’ve solved their healthcare access problems. Or we’ve implemented a post discharge meal program for people who are hospitalized for that, you know, they have a meal waiting for them when they get home.” These measures don’t address what happens when patients leave the hospital and are on their own, and the “self-celebration” in the industry doesn’t make enough of a difference. One reason for insignificant change, Dr. Jain says, is how those social determinants of health and their effects are defined.
“I’m just a doctor/nurse. I can’t solve society’s problems.”
Interviewing Dr. Jain, Quality Reviews CEO, Dr. Edward Shin poses the question: “How can healthcare workers address systemic issues that impact care?” Dr. Jain’s solution is to engage professional societies and even our government to exact change of vulnerable patients.
“I think that we are all a part of professional societies, and each one of those professional societies are engaged in advocacy efforts on our behalf if you’re part of a large health system,” Dr. Jain states. He also believes that healthcare organizations should be trying to train people in the community, and giving decent paying jobs to people in the community. He says, “That’s a very different statement of our commitment, and it’s a different way of actually serving the community.”
While many healthcare providers believe their jobs are done once the patient leaves their offices, cultural organizations like an African American medical group that addresses the needs of the Black community with the leadership of Black doctors, or even a Korean medical group that speaks the language and is helmed by members of the Korean American community, can and do make a significant impact in improving health social determinants.
Getting cultural groups involved can help to create positive change for those communities most impacted by the social determinants of health, on top of the ones that hospital systems are already putting in place. While factors like insurance and a hospital’s bottom line may leave a doctor feeling like their hands are tied, meeting the needs of patients and having compliance could make a difference in their lives, too.
Speaking of Provider Burnout…
Dr. Jain and Dr. Shin discuss the problem that has only gotten worse over the last 20 months––provider burnout. Healthcare professionals are fleeing the industry as fast as the virus is mutating. Despite efforts to help providers, Dr. Jain says that efforts act as a bandaid, “I think we’ve dealt with this issue by telling people to meditate and go to yoga retreats and give them access to the Headspace app. Nothing against the app, but I think we’re treating the symptoms, not necessarily treating the cause.”
He explains that the cause is asking people to work harder and in less time, without managing the “administrative complexity” of it. He says, “To be really blunt and direct about it, if you’re not practicing, it’s very easy to tell people what to do.”
Dr. Jain believes that taking on fewer patients should be the goal, since managing a smaller caseload can decrease the risk of burnout. However, the pandemic has added to an already existing problem, and with some hospital systems being overwhelmed, it is understandable that mental health care and meditation apps might be encouraged.
Dr. Jain also equally places blame on physicians who don’t want to participate in community efforts and efforts to engage. “When asked to participate in committees, or the design of activities, people will raise their hands and who’s going to pay me for that time?” Some are reluctant to spare a couple of hours, which leads to a decreased likelihood of positive changes.
The Bottom Line
Tackling social determinants of health takes more than sending a shuttle to pick up a patient. All aspects of society need to be involved––from the government to the very communities where individuals live. While doctors may be limited in what they can do, they are able to advocate for their marginalized patients within their groups and by being empathetic to the various factors that impact treatment plan compliance.