Tackling Social Determinants of Health in Boston

The Social Determinants of Health Grand Rounds is a series of lectures that addresses the social, economic and environmental determinants of patients’ health at Boston Medical Center. The program was established two years ago by residents frustrated with readmissions and lack of access to care for their patients.

By inviting experts in patient advocacy and health care policy to share their research and experience, residents aim to foster a dialogue across departments and professions about the social context of the health care system.

“We needed to include medical students and faculty and get buy-in from other departments if we were going to make the project work,” said Dr. Hannah Watson, CIR Massachusetts Regional Vice President and co-founder of the project. After meeting with leaders from various departments, residents were able to find out which issues were most important. Since then, the committee behind the project has grown to include medical students and attendings.

Now, several departments offer one grand rounds slot per year addressing social issues on particular health outcomes. For example, earlier this year OB/GYN residents wanted to know more about gender-based violence and how to identify warning signs. More than ten sessions have taken place and residents expect to host six more in the upcoming academic year. Hundreds of attendees have participated including PAs, residents, nurses, medical students and other hospital staff. In infectious diseases, education on HIV and prison health was key for residents in treating their patients.

“[This program] is a small step toward creating a space in academic medicine to address underlying issues of our patients,” said Dr. Rachna Vanjani, OB/GYN.

“There is a real disconnect between where people live and work and the tremendous impact it has on their health, in many ways during residency we end up playing catch up with underlying issues,” said Dr. Watson. “Things like poverty and housing insecurity affect almost every patient who walks through the door, but most of us never ask our patients about any of those issues. In a busy clinic it’s easy to push aside someone’s social reality and revert to thinking in our medical comfort zone. But it’s so important that we remain curious about the world our patients come from.”

Working in teams is essential to helping patients get better, including working with social workers and the legal community.

“In pediatrics, doctors had patients who were constantly in and out the emergency room and ICU for asthma and respiratory-related issues and we were finally able to decrease repeat visits by partnering with a team of lawyers who found out that the cause of many of their patients’ problems was unsafe living conditions in their apartments or housing shelters. They were able to contact landlords in public housing on behalf of their patients. It made a big difference,” said Dr.Rachna Vanjani, OB/GYN.

BMC residents will continue the grand rounds program reaching hundreds of residents, nurses, medical students and other healthcare workers. Residency isn’t easy and there are challenges to ensuring that residents have time for both clinical work and didactics. When residents set out to create a new project, they needed to do it in a way that didn’t interfere with patient care.

“This program works because it’s a way to integrate social determinants and practical information into the existing structure of residency that doesn’t require any additional time commitment or effort for the housestaff who attend because residents are required to attend grand rounds anyway,” said Dr. Watson.

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