What Patients Bring to the Medical Encounter: Dealing with the Whole Patient

The overall objective of this case is to provide students with an opportunity to focus on the important aspects of the social history and how it relates to the current medical issues at hand. In this session we want to focus on their skills in obtaining adequate and useful information about the patients’ social context in the medical interview. The case is written at the level of M1/M2 students. However could easily be adapted for higher level learners.

In the implementation of this case at our medical center we have asked students or the facilitator to at the least read the findings aloud. Some groups have opted to present the information as a role-play exercise. Thus far, we have not included a standardized patient, but that could be one adaptation of the case.

Session Overview & Format

This is a phased case that comes in 3 parts:

• Component 1: written assignment to hand in and review during the first part of class
• Component 2: small groups of 3-12 students (45 minutes)
• Component 3: small group s of 3-12 students (45 minutes)

Intended Learning Outcomes

Students should be able to:

• Describe health data within immigration context
• Discuss social determinants on health
  • Identify how education, literacy and social economic status might impact health
  • Assess Patients ability to read and understand information/instructions
  • Assess how finances and/or insurance influence health care and adherence to recommendations
• Understand the importance of physician-patient negotiation
• Assess and enhance patient adherence with communication skills
• Develop communication, interaction, and interviewing skills
• Assess identified stressors in patients life

Written Assignment

The written assignment is used to promote self-directed learning and reflection in the area of social determinants of health. Additionally, the assignment is meant to promote student learning in the areas of prevention and screening. The assignment insures that students have read the assignment and come to the small group prepared. This assignment is not graded, but was reviewed prior to the session by the faculty facilitator.

Facilitators can decide whether or not they want to review these assignments in the small group setting and should plan their time accordingly.

Participants who complete this module will be able to:

1. Describe health data with in immigration context.
2. Discuss social determinants on health.
3. Identify how education, literacy and social economic status might impact health.
4. Assess patients ability to read and understand information/instructions.
5. Assess how finances and/or insurance influence health care and adherence.
6. Understand the importance of physician-patient negotiation.
7. Assess and enhance patient adherence with communication skills.
8. Develop communication, interaction, and interviewing skills.
9. Assess identified stressors in patients life.

Safeer RS. Keenan J. Health literacy: the gap between physicians and patients. Amer Fam Phys. 72(3):463-8, 2005 Aug 1.

Echeverria SE. Carrasquillo O. The roles of citizenship status, acculturation, and health insurance in breast and cervical cancer screening among immigrant women. Med Care. 44(8):788-92, 2006 Aug.

Behbakht K, et al. Social and cultural barriers to Papanicolaou test screening in an urban population. Obstet Gynecol December 2004;104:1355-61

Weiss, BD. Removing barriers to better, safer care, Health literacy and patient safety: Help patients understand: Manual for clinicians, Second edition. This Electronic Resource can be found on the American Medical Association’s website.