A Tale of Two Patients

Abstract

The disparate effects of social determinants of health (SDOH) on cardiovascular (CV) health status and health care have been extensively documented by epidemiology. Yet, very little attention has been paid to how understanding and addressing SDOH might improve the quality of clinical interactions, especially by improving patients’ adherence to recommended therapies. We present a case and suggested approach to illustrate how cardiovascular clinicians can use patient-centered approaches to identify and address SDOH barriers to adherence and reduce the impact of unconscious clinician biases. We propose that CV clinicians 1) Recognize that patients may have different belief systems about illnesses’ cause and treatment, which may influence their actions, and not to assume they share one’s experiences or explanatory model; 2) Endeavor to Understand the individual patient before you; 3) Based on that understanding, Tailor your approach to that individual. We suggest a previously-developed mnemonic for an approach to RESPECT the patient: First, show Respect; then elicit patients’ understandings of their illness by asking about their Explanatory model. Ask about the patient’s Social context, share Power in the interaction, show Empathy, ask about Concerns or fears, and work to develop Trust by building the relationship over time. We provide additional clinical resources to support these efforts, including lay descriptions of cardiovascular conditions, challenges to adherence and suggested strategies to address them.

Addressing the Social Needs of Hypertensive Patients

“…34, 35 The interaction with race suggests an intriguing possibility that this expression of caring might be particularly important for Black patients where social distance is greater. 36 Another possibility is that discussions about patients’ social-demographic circumstances might be a marker for other good communication behaviors by the provider that promote adherence that were not captured in this study (i.e., responding to patient emotion). Future research should test the plausibility of these hypotheses to help elucidate the pathways through which conversations about social-demographic circumstances ultimately improve patient adherence.…”

Diversifying Dialogue: A Physician’s Primer to Procuring all Points of View

“…When an encounter begins with a patient and family, it is not always obvious to ask for permission to start [11]. Asking for permission is a small sign of respect and improves the first impression [11].…”

“…When an encounter begins with a patient and family, it is not always obvious to ask for permission to start [11]. Asking for permission is a small sign of respect and improves the first impression [11]. Many patients have experienced an asymmetric model of control over the encounter with physicians in the past, putting them at odds with a physician seeking to control the conversation for expediency in such processes as consent [11,12].…”

“…Asking for permission is a small sign of respect and improves the first impression [11]. Many patients have experienced an asymmetric model of control over the encounter with physicians in the past, putting them at odds with a physician seeking to control the conversation for expediency in such processes as consent [11,12]. Starting off a phone encounter or a first time visit with "Is now a good time to talk?"…”

“…or "Would it be alright if I sit and talk with you?" restores the patient's autonomy where they previously felt captive [11].…”