Doing Better for the People We Serve
What COVID-19 is revealing about empathy in healthcare, and why social determinants of health build a bridge to better outcomes.
On my first day working for City Government, I attended a two-day orientation for new employees. No matter what type of employee or what department you worked for, you came to the same orientation. In a small, hot, windowless room we heard about harassment, ethics, labor laws and benefits. We filled out forms and drank lukewarm coffee out of styrofoam cups and watched a video about ensuring we don’t take hallucinogenic drugs at work.
I sat next to a really charming young man — let’s call him Charles. Charles was a new employee for Public Works in road repair. Charles was talkative and funny and smart; he was an aspiring musician and father of two young girls. I learned all about his life in the first 15 minutes of being there. I don’t think Charles stopped talking for the entire free time we had before the orientation started.
A change in social behavior.
The minute that “class” began and the HR employee went to the front of the room to “teach” us, Charles shut down. He slumped in his seat when we were ordered to make name tags. He mumbled his intro when we were forced to go around the room. He made sarcastic side comments and rolled his eyes when it was time for group activities. Charles had transformed from a vibrant grown man into a petulant teenager within the span of an hour.
I thought for a long time about what had made Charles turn so quickly. None of us wanted to be stuck in that room for two days, but not all of us were so obviously irritated. Some of us were eager to please the instructor; some of us had just sort of checked out and were trying their best to covertly multi-task. As I looked around and noticed other men with Charles’ posture, it occurred to me that the dynamic in the room was creating a power balance similar to school. Charles and the others reminded me of some of my high school friends. Maybe Charles hated school; maybe his teachers had talked down to him, disregarded him or made him feel stupid. Maybe there were unhappy associations with the institution of school that triggered a slumping muscle memory.
On the second day, I sat next to Charles again. I mentioned off-hand that this reminded me of high school, and Charles said “yah, me too. I feel out of place all over again”.
The systemic threats of Karen.
“…she would fail to see beyond his current behavior to understand why certain interactions and institutions would trigger certain responses.”
This memory popped into my head recently when I was presenting some research on health inequities. A woman in the “audience” (i.e the Zoom) asked why those people in New Orleans were getting sick and dying at higher rates than others. This woman — let’s call her Karen — seemed beside herself. Even when I tried to explain patiently about access to care, generations of racist policies and a broken social trust, Karen wasn’t having it. She was adamant she had the answer and that it all stemmed from ignorance or a lack of education. Finally, after it was clear she wasn’t letting up, the moderator of the event muted mics and ended the conversation.
Over the course of my career, I’ve met many Karens. I can spot them a mile away at any event. Karen would disregard Charles in a second — she would fail to see beyond his current behavior to understand why certain interactions and institutions would trigger certain responses.
I see the same patterns play out in Healthcare conversations every day, especially in the age of COVID-19. If we fail to understand the whole person — their environments, their struggles and their triumphs — we will keep repeating the same dynamics and foolishly expect different results.
When Charles goes to the doctor, will he act just as evasive in the exam room as he did in the orientation? When Charles’ wife is struggling with postpartum depression, will she feel comfortable opening up to her OB-GYN without fear or shame? Will Charles’ father proactively seek care for his Diabetes, knowing full well the doctor will tell him to eat healthier and exercise, even though he lives miles from a store, has no car and is afraid to walk in his neighborhood?
A prescription for equity in healthcare.
You can’t distill a person down to their zip code data, but you can use what you learn to approach a situation with compassion and provide the best care you can.
Healthcare providers can’t prescribe a total shift in social equity. Doctors and nurses can’t undo a history of oppression. But, these front-line teams can take into account different types of patient data to more fully know the people they serve. Medical Education can integrate into their curriculums a more nuanced understanding of the role race, class, gender identity and sexual orientation plays in the hesitance to seek medical treatment. And everyone who serves others can take the time to unpack their own implicit biases and work harder to unlearn bad habits.
Getting a snapshot of a patient’s Social Determinants of Health doesn’t take long, but many providers lack experience in having uncomfortable conversations about poverty, housing or education. That’s why our team at mySidewalk is working to develop patient conversation starters on Social Determinants that combine meaningful data on social risk with proven ways to talk about tough things and engage a patient’s entire story.
Being known is perhaps one of the most basic human needs — it spans borders and generations. You can’t distill a person down to their zip code data, but you can use what you learn to approach a situation with compassion and provide the best care you can.
As healthcare works to improve patient care outcomes and experiences with the holistic lens of social determinants data — effective data storytelling should be the guiding light. I’m incredibly proud of the work the mySidewalk team has done helping public health tell these stories, and inspired by the work we already have underway with leading healthcare organizations to further bridge the fields through Social Determinants of Health.
Check out this recorded webinar to continue learning best practices on data storytelling and framing effective health messaging, or this podcast I conducted with Abner Mason (CEO, ConsejoSano) on equity in healthcare.
Lastly, if you’d like to stay up to date with our patient conversation starters — or share your own insight — feel free to shoot me a message at smartin@mysidewalk.com. I’d love to hear how you’re using (or want to use) this type of data in your work.
This article is the first in a series addressing Social Determinants of Health & how to best utilize them for better health outcomes. To stay up to date on these publications, make sure to follow Community Pulse.
