Understanding the Family: the power of a careful social history

Perhaps it is my week to be inspired by others blog posts. In the post Do You Like Your Pediatrician? Yolanda MD comments on the importance of forming an emotional connection with patients. After the first visit to her baby’s pediatrician she felt ambivalent about the experience because the doctor did not:

ask any personal questions to get a sense of who we were as a family. … I would expect that knowing the social context of a new patient is an important step to building rapport.

Recently a colleague of mine retired. When I joined the practice 11 years ago he took me under his wing. We are both athletes at heart and love to see patients who are athletic themselves.  Sports injuries were fun for both of us; he taught me lots about broken bones, sprains and tears. He was emotionally wise as well. It was him I turned to fess up to a third not-so-well timed pregnancy. I had just been hired and was fearful of being let go after a trial period so I hid in a too-large white lab coat until I was 20 weeks along.  Then one afternoon I screwed up my courage and sat in his office.

I, um, have something to tell you….

Now I can still remember my sense of peace and confidence when he simply smiled and warmly said his congratulations.

When he was close to leaving our office this winter I battled my own sense of loss by asking two things of him. I asked to have him refer those patient-athletes to my practice and I asked for some of that emotional wisdom. Specifically I asked him for his advice for bonding with the difficult to win over parents and patients. How did he handle the hard to convince or the distant families?

It is likely many a young pediatrician is caught up by the same struggle. My friend’s answer was a simple one. Slow down and really get to know the family as a whole. Ask about their lives outside of our office. Be sure you know what they do, where they live, what motivates them.

This was easy advice to follow with parents that I had a natural affinity for, less so for the ones that challenged me. But, by focusing on his wisdom I have learned to not take it personally when a particularly overbearing mother asks for yet another unneeded lab test; I now know that she had a sister die of lymphoma. I understand that one child who returns again and again for very small issues has both parents newly out of work, they are seeking control of something in their lives. One seemingly aloof mother that puzzled me became clearer when I began to understand more about her marital struggles.

Indeed, “knowing the social context of a new patient is an important step to building rapport”. In fact, it is crucial and the gift of better understanding our patient’s families is a gift worth working to receive.

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4 thoughts on “Understanding the Family: the power of a careful social history

  1. This is an excellent post!

    I think that’s true of all provider-patient relationships. If you know what else is happening in their lives, you get clues on compliance, mood, etc. Very important if you really want to help a patient.

    Thank you for sharing this!

    1. You make a great point. Of course, connecting with the people we help is crucial, no matter what our role in helping is. And, in terms of medical practice I also very much agree with your comment about compliance – how can well help with compliance if we do not understand more of the whole person behind the patient?

  2. I find it fascinating how easily people can fail at compliance, and how easy it is to help people be more compliant.

    I had a client who was struggling to take meds and I saw they had a smart phone. I walked her through downloading an medicine reminder app, and within weeks she felt better – as she was finally taking her meds as prescribed rather then whenever she remembered.

    I, as a provider, get very frustrated when a client won’t comply with treatment plans – mine or someone else’s – and then complain that it’s not helping. Figuring out what will work in a client’s life so they will do their part, makes everyones life easier in the long run and the often improves the patient’s life.

    /end rant on compliance

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