Last month, a video of an MIT neurosurgeon explaining his decision to leave medicine went viral, revealing many of the frustrations that have long plagued millions of health care workers.
The most obvious is burnout: One survey found that more than half of U.S. physicians experience burnout, with the numbers highest among emergency medicine, internal medicine, obstetrics and gynecology, and family medicine physicians. Another study that looked at physician guidelines versus current patient demands suggests that primary care physicians spend 26.7 hours a day seeing patients. average Number of patients.
Recent petitions diagnose the cause as moral injury, a phenomenon in which health care workers are forced to abandon their ethics and prioritize the business needs of their hospitals over those of their patients, as explained in another topical essay. One survey suggests that eight in ten doctors have experienced moral distress during the pandemic, and another article suggests that more than 70% of emergency physicians agree that “the corporatization of their field has had a negative or very negative impact on the quality of care and their own job satisfaction.”
But beneath the surface of burnout and moral injury, something else is happening in medicine: doctors, pressed for time and resources, are unable to treat the underlying causes of their patients’ suffering.
The MIT neurosurgeon likens what happens to his patients to fixing a leaky house. Just as ripping out moldy drywall and putting in new wall does little to stop the underlying leak, removing a bulging disc and installing titanium spinal rods does little to treat the underlying cause of a patient’s pain. Regardless of the type of surgery, he says, the patients who recovered the fastest were those with healthy lifestyles, stress coping mechanisms, and good social support.
Which begs the question: Why can’t doctors prescribe those medications too? Why can’t the prescription include activities that help patients find ways to cope with stress, get moving, spend time outdoors, find deep, lasting relationships?
More health care workers around the world and in the United States teeth They accomplish this mission through an increasingly popular practice called social prescription, in which health care providers refer patients to non-healthcare resources and activities aimed at improving their health and strengthening their connections to their communities. Instead of asking, “What’s wrong?” and Social prescriptions ask patients to think about what’s important To What about you?” and appeals to medical professionals to help get there.
This practice responds to the basic truth that up to 80% of our health is determined by the environment (social determinants) we live in. To survive, we need basic resources like clean air, trees, nutritious food, shelter, and money. And to thrive, we need sources of joy, meaning, and relatedness – reasons to get up in the morning, things that make us feel healthy, and connections to the things that matter to us.
So by prescribing patients activities like cycling groups or art classes, and resources like food, legal support and transportation, social prescribing helps patients meet these basic and psychological needs, improving their ability to manage their own health issues and improving health outcomes overall.
The practice began in the UK, the first country in the world to create a Minister for Loneliness. The issue was exacerbated when the National Health Service estimated that one in five doctor appointments is made for non-medical, purely social reasons. This puts further pressure on doctors as they have less time to see patients with medical problems in a system already plagued by understaffing, long backlogs and widespread burnout.
Therefore, to save doctors’ time, social prescribing is often carried out with the support of link workers – health professionals whose role it is to listen to patients, understand what is important to them, and then connect them accordingly to community activities and resources.
“Instead of searching on Google, you find great organisations by walking around your neighbourhood and understanding who is in your community,” says Gay Palmer, one of the UK’s first link workers. In other countries, the role of link worker is filled by social workers, health coaches or volunteers.
“Tears and frustration are flowing. [in that first conversation]So all I have to do is listen and translate. [doctors] Help them understand what is happening and why [the patient] These attendances are frequent,” Gay said.
This translation and reorientation has proven effective: Studies have shown that social prescription leads to reduced doctor visits, emergency department visits, hospitalizations, and overall health care costs, all of which reduce strain on the health care system.
It’s no wonder then that a survey found that the majority of UK GPs (59%) believe social prescribing could reduce their workload.
But beyond giving physicians time to focus on patients with clinical needs, social prescribing can also remind them to: their Your own needs and why you went into medicine in the first place.
This was certainly true for Ardeshir Hashmi, MD, Endowed Professor of Geriatric Innovation at the Cleveland Clinic and one of the earliest adopters of social prescription in the U.S. He first encountered social prescription while working at Massachusetts General Hospital, where he encountered a 93-year-old patient named “Ruth” who was visiting the emergency department every two weeks complaining of chest pains.
“Everyone thought, ‘Oh, there must be something wrong with her heart or blood vessels,'” he explains. But when he discovered that Hashmi’s chest pain had gone away by the time she reached the hospital, he also learned the underlying cause of her pain: She was alone.
Her grandson, who was her main social support and who took her to ballroom dancing lessons, was going off to college. The solution? Arrange for her aged care manager to take her to ballroom dancing again.
“Lo and behold, we eliminated all emergency room visits! It was that simple.”
When Hashmi arrived at Cleveland Clinic, he was determined to make socially determined, patient-driven care the standard. He created patient councils and recommended that doctors have 90-minute conversations with patients and give them “prescriptions” based on those conversations. Then, working with community partners and software platforms, the doctors would prescribe community connections, like walks through a local botanical garden or a home visit through an arts center.
The result, says Hashmi, is hundreds of patient stories like Ruth’s, but he believes the benefits extend beyond patients to healthcare workers too.
To remind Ruth of the value of social prescriptions, Hashmi keeps a card on his desk that Ruth’s children sent him with an encouraging message: “Thank you for giving us our mom back.”
Julia Hotz is a solutions-oriented journalist based in New York. Her articles include The New York Times, WIRED, Scientific American, The Boston Globe, TimeShe helps other journalists report on big new ideas that will change the world with her Solutions Journalism Network. Therapy for ConnectionSimon & Schuster Publishing, This piece was excerpted from.
