One of the most commonly asked questions we get at CCMU is how we define “medically underserved.” Our answer is that the medically underserved are those who are vulnerable to poor health. A person’s health is shaped by countless things, but our life circumstances are a major determining factor. These life circumstances that affect our health, known as the social determinants of health, can include: whether or not we have health insurance or the funds to afford needed services, our fluency in the English language and our understanding of basic health care terminology, our access to stable transportation, safe housing, healthy foods, and much more. When a patient facing a number of these barriers to good health seeks health care services, the challenges they face in their daily lives may not be apparent to their provider. The invisibility of these social factors in the exam room might mean that their prescribed treatment plan is unmanageable or inadequate for their needs and resources. This results in noncompliance, frustration, and ultimately, poor health.
Medicine, as a field, holds evidence-based care in high regard, but when results don’t line up with what the evidence suggests, it’s important to go back to the evidence and look for another approach. So, CCMU did just that—we looked at the evidence to try and understand the roots of noncompliance, and learned that what appears as noncompliance can often be understood as someone struggling to navigate difficult circumstances. Someone who shows up late to an appointment may rely on unpredictable and limited bus schedules. Another who does not fill prescriptions could be facing issues affording basic things like food and shelter. A third who isn’t following through on important lifestyle changes may not have fully understood the recommendations or may be working multiple jobs or juggling childcare. For providers, understanding and embracing the innate challenges of a patient’s life as part of providing complete care requires empathy. As for evidence-based care, research shows that providers who empathize with their patients overall have better health outcomes.
If we want to maximize good health outcomes and create a health care system that meets the needs of all Coloradans, we must embrace this evidence and commit to whole patient care. To this end, CCMU created a video that illustrates how social determinants of health may appear in a typical medical setting, and also includes data and interviews from some incredible providers in our state. We aim to have the video incorporated into the curricula of the schools around the state tasked with training future health care professionals. We also hope that with the help of the video and its complementary discussion guide, we’ll spark conversations and new ideas for providers to integrate into their own practice.
While the larger goal of addressing these social factors is a society-wide effort and far outside what providers are trained and able to do in their day-to-day work, change can begin in the exam room. When providers better understand patients’ lives and empathize with the barriers to good health that they are facing, it can dramatically alter how they care for their patients. Patients, in turn, can be more empowered to do what is right for their health. The art of health care is much more than clinical science and diagnosing illness—it is a healing of the mind and body that is only possible through recognition of the role our life circumstances play in our health.