Path to Prioritizing SDoH in Whole Person Chronic Care: Q&A series featuring Dr. Rosemay Michel, D.P.M.

It is crucial to consider social determinants of health (#SDoH) to appropriately address patients' unique challenges and needs and provide meaningful and #compassionatecare. This involves engaging multiple sectors to tackle the systemic, environmental, and social factors impacting patients' well-being.

In this edition of our SDoH Q&A series, we are honored to discuss this vital topic with Dr. Rosemay Michel DPM, FACPM, FFPM RCPS(Glasg.) , who serves as an officer of the American College of Podiatric Medicine and is also an active committee member of the American Board of Podiatric Medicine (ABPM) Medicine. She's also a residency program evaluator for the Council of Podiatric Medicine and a consultant to The University of Texas Rio Grande Valley School of Podiatric Medicine. By recognizing the significance of social determinants of health and engaging in such insightful conversations, we can strive towards delivering comprehensive care.

Q: What should clinicians be asking their patients living with chronic conditions to better understand the challenges they are facing specific to SDoH?

Clinicians should discuss family background, where they live, where they grew up, lifestyle, family life, housing situation, and type of employment with patients. Also, it is important to try to ask about their cultural norms, values, beliefs, and certain behaviors. Responses to these questions will help guide clinicians regarding caring for patients of a specific population, group, and/or cultural background.

Q: Are there any approaches your organization or other leading organizations in healthcare are taking to prioritize SDoH needs for people living with chronic diseases?

In my organization, providers are encouraged to inquire about concerns related to SDoH and involve their assigned social worker to assist. The key is involving multiple sectors to address the systemic, environmental, and social factors affecting patients’ health.

To address SDoH/cultural competence, the Joint Commission and National Quality Forum have developed some standards and measures in this area as well.

Q: What should an SDoH-first approach to care actually look and feel like for a patient?

The approach should be casual, caring, respectful, and nonjudgmental. Patients should feel truly respected, not judged, and comfortable sharing their backgrounds and experiences freely. Ideally, a provider from the same background who can communicate effectively and identify with the patient is most favorable and relates better to the patient’s needs.?

I am reminded of providers in the Indian Health Service , a comprehensive healthcare system for federally recognized American Indians and Alaska Natives in the U.S. The system is authorized to utilize an Indian Preference policy in hiring in order to encourage qualified candidates of Native descent to apply.

Q: How can patients best communicate their SDoH needs to their care providers? Patients rarely realize they have SDoH needs unless faced with a specific challenge.

Only patients who recognize the challenge and will share and/or ask for help may result in acknowledgement of their needs by their providers. It is the job of providers to ensure patients feel comfortable enough to share and trust that they will be heard. Providers must recognize that patients want or need to share details that go beyond basic history.

Q: If a person is not receiving the care they need related to SDoH, where else can they go for support beyond their primary care provider and team of care specialists?

Patients should have the ability to seek resources in their communities, which necessitates state and federal governments to institute accessible programs. Most often, patients ask those close to them — family members, work colleagues, neighbors — for information on potential resources.?

Q: When clinicians are more overburdened than ever, how can they best prioritize SDoH in the shortened care visit of today and beyond?

It is imperative that providers make the time to “park by the bedside,” which helps assure patients that the provider is interested in hearing their concerns and is taking the time to do so without distractions. Another resource is having nurses ask leading questions during a patient’s intake — this helps open the door for meaningful discussion with the provider.

My personal approach is to ask patients where they are from and typically strike up a conversation about their hometown and their background. I find this puts most patients at ease.

Q: What innovations specific to SDoH do you think hold the greatest promise today and in the next 5 years?

I’m not aware of any specific innovations addressing SDoH that currently exist. I imagine there are some AI innovations in the works, but until AI can “feel,” questions regarding a patient’s SDoH needs, we may only relegate it to recognition by humans.