Socio-Medical Trainwrecks

I don’t know if the term “socio-medical” even exists.

But it felt like every single pathology I dealt with today was a social problem.

Ulcer, exercerbated by no medications (damn pre-authorization!), and no food. In an unstable housing situation, with limited transportation. And serious medical issues taken lightly by a local hospital. My diagnoses: Unstable food, housing, transportation, respect.

Renal failure, hospitalization never followed up because they had no way to get to clinic. Ongoing exhaustion and decreased appetite ignored. Here for follow up labs. My diagnosis: lack of medical transportation, no clear communication of medical supports.

Gastroenteritis (was this even the diagnosis?), unable to access hospital records. What happened? Dunno. What tests done? Dunno. What medical diagnosis? Dunno.  My diagnosis: no communication between EMRs.

When social issues turn into medical issues. Socio-medical.

Bio-psycho-social means the biology and the psychology and the social world are all intertwined.

But by socio-medical, I want to say: social IS medical.

I want “no housing” as a diagnosis. “No food” as a diagnosis. “No respect from the medical establishment” as a diagnosis.”No EMR interconnectivity” as a diagnosis

If we pathologize social conditions, and recognize social conditions as medical problems, then can we convince our medical system to pay to improve social conditions?

If medical insurance were to pay for housing, or food, or EMR interoperability, how much would insurance companies save on hospital bills?

4 thoughts on “Socio-Medical Trainwrecks

  1. As usual, right on target. I have to say, I very much admire you for choosing to work in this challenging clinical environment, and for sharing your experience. I feel like few docs have the passion to tackle what you manage on a daily basis. Fewer would stick with it. I know I myself burnt out of a similar experience years ago. I wasn’t even as immersed as you are, and I fizzled out, walked away. Even now, years later, I don’t have the internal resources to even volunteer in a setting such as yours. But, someday, when my kids are older and more independent, and I feel like I’m sleeping again, and not completely preoccupied with parenting little ones, I hope to inch back in, to give back. Obviously, I feel very guilty about working in a highly-resourced, supportive environment with generally well-educated, higher-income patients… and loving every day of it. Half of my patients are healthcare providers. But, I know for a fact this is all I can do right now, or I’d quit clinical medicine.

    • I’m noticing that the old-timers in the community health center don’t have families. Some of the new docs do, but most haven’t stuck around once they have babies. I don’t know if I’d be able to have children AND work at this clinic. Caring for patients draws on emotional resources, their care requires close oversight. Kind of like a family. Thank God for great colleagues and a supportive medical team. LOVE my pharmacists. And health educator. And baby case managers. And still I can’t imagine doing more than two days each week. It’s not enough, but it’s everything I can do.
      You are an inspiration as you care for your family with grace, and instead of giving back you are giving forward, raising them to care for others. Bringing them to the animal shelter feeds your soul and builds in them a sense of responsibility to other lives. And somehow you manage that along with your clinic patients!
      And what we “should” do as doctors is what we “can” do, without quitting.

  2. Dear Dr Jones

    Thanks for continuing to share your stories. You are a great advocate for changing systems to help people live safely

    Cheers !

    Vince Keenan

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