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Look to Social Aspects of Health Not Just Biology, Say Researchers

It's a common scenario in many emergency departments (EDs): A man with a long history of homelessness and schizophrenia reports hallucinations and thoughts of suicide. Should the medical team admit him for hospitalization or treat him with antipsychotic drugs and release him from the ED? Lessons learned from this experience are the focus of the first article in a series of case studies that began November 15 in the New England Journal of Medicine.

The series will highlight examples of how physicians should practice "social medicine"—understanding how social forces, such as income, race, ethnicity, immigration status, and residence, often impact health and treatments.

"Medical schools in the United States are much better at teaching the biological mechanisms of disease rather than the social determinants of health," says Jeremy Greene, MD, PhD, the Elizabeth Treide and A. McGehee Harvey Chair in the History of Medicine at the Johns Hopkins University School of Medicine. "Many clinicians are prone to think of these social factors in fatalistic terms, but with the right attention to social science, the social context of health and illness can be malleable, where clinicians can have a substantial impact as advocates for their patients."

The idea for the series, called Case Studies in Social Medicine, began with a grant from the Open Society Foundations and led to a case workshop conference in May hosted by the Johns Hopkins Center for Medical Humanities and Social Medicine, which Greene directs. Greene and eight other experts throughout the United States will edit the series, including Scott D. Stonington, MD, PhD; Seth M. Holmes, MD, PhD; Helena Hansen, MD, PhD; Keith A. Wailoo, PhD; Debra Malina, PhD; Stephen Morrissey, PhD; Paul E. Farmer, MD, PhD; and Michael G. Marmot, MB, PhD.

Greene expects NEJM will publish approximately a dozen case studies over the next year. Each is coauthored by clinicians and social scientists and offers concrete advice for physicians who experience similar issues in their own practices and teaching of core concepts in social science in medicine.

In their introductory essay to the NEJM series, the editors wrote that medical students are often trained to reduce the complex social history of their patients to just three elements: alcohol, tobacco, and illicit drug use. They are trained to focus on the biological and behavioral elements that contribute to health rather than the social aspects of the world in which their patients live.

Medical board exams that emphasize biological over social knowledge are also complicit in devaluing social factors that influence health, Greene says.

"Too often, social medicine is thought of as a 'touchy-feely' thing that would be nice to learn if one had the time, but that learning core biological concepts is more important," Greene says. "The reality is that both are equally important—and we hope this case series offers a new way for clinicians and educators to value the importance of social science in medical practice."

The editors wrote that the series encourages physicians to look within their own practices to understand how social factors influence health on an individual, community, or society level. And that, like biological factors, social factors should be a focus of medical study and interventions.

Source: Johns Hopkins Medicine