To the Editor:
“The patient does not smoke and drinks occasionally.” This, sadly, is the patient's social history as recorded in too many of our medical records.
The social history has fallen into disrepair. Physicians can and must do better. In the drive for efficiency and reliance on technology, the connection between patient and doctor need not be lost.1 We should aim to at least equal good hairstylists, who keep track of personal details on cards or in memory so they can make connections with their clients. “So how is your son doing in college?” “Did you plant a garden again this year?”
Along with the chance to connect with the patient as a person, the social history can provide vital early clues to the presence of disease, guide physical exam and test-ordering strategies, and facilitate the provision of cost-effective, evidence-based care. For example, the golfer who no longer golfs due to dyspnea on exertion is developing the first signs of heart failure, lung disease, or anemia; if the doctor doesn't know about this change and must wait for other clues, valuable months are lost.
For one patient with COPD who came to the emergency department, the social history, with a simple question about pets, revealed crucial data. “My dog becomes visibly agitated and starts barking after smelling my breath when I'm getting sick,” she offered quickly when asked. Literally, her dog caused her to seek care.
How can we physicians change the culture of our institutions to promote the taking of a proper social history? We must role-model how to take a social history for our trainees and peers. An illustrative poem or short work of literature can be incorporated into morning report or teaching rounds. In these and other ways, we must encourage trainees and peers to spend dedicated time with patients, sitting down and getting to know them as people. With careful listening, the focus of the physician can be directed to what is most important to the patient.2 By knowing patients better—and taking better social histories—we will provide better care and will be more fulfilled and energized in our work as physicians.
Ruric (Andy) Anderson, MD, MBA
Assistant dean for medical education, NorthShore University HealthSystem, and clinical associate professor of medicine, University of Chicago Pritzker School of Medicine, Evanston, Illinois; firstname.lastname@example.org.
David Schiedermayer, MD
ThedaCare Palliative Medicine Service, Theda Clark Medical Center, Neenah, Wisconsin.
1 Verghese A. Culture shock—Patient as icon, icon as patient. N Engl J Med. 2008;359:2748–2751.
2 Haidet P, Paterniti DA. “Building” a history rather than “taking” one: A perspective on information sharing during the medical interview. Arch Intern Med. 2003;163:1134–1140.