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From helplessness to transformation: An analysis of clinician narratives about the social determinants of health and their implications for training and practice.

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Title: From helplessness to transformation: An analysis of clinician narratives about the social determinants of health and their implications for training and practice.
Authors: Peebles, Erin R., Pack, Rachael, Goldszmidt, Mark
Source: Medical Education. Nov2023, Vol. 57 Issue 11, p1054-1067. 14p.
Subjects: Psychological burnout, Social determinants of health, Hospital medical staff, Attitudes of medical personnel, Physician-patient relations, Work, Physicians' attitudes, Medication errors, Curriculum, Medical care costs, Experiential learning, Emotions, Psychological adaptation, Medical education, Psychological distress, Patient safety
Abstract: Background: Medical curricula are attempting to prepare trainees to address the social determinants of health, however the life circumstances of patients are often beyond physician control. Little is known about how physicians cope with this dilemma; we sought to examine their perspectives when faced with this challenge to help better prepare trainees for practice. Methods: We undertook a critical analysis of physician narratives from January 2018 to June 2020. In total, 268 physician‐written narrative social determinant of health pieces from four high impact medical journals were screened and 47 met the inclusion criteria and were analysed. Results: We identified four storylines that described the physician experience and strategies for coping with the social determinants of health. While Helplessness stories described authors' experiences of emotional distress when unable to support their patients, the other story types described ways they could make a difference. In Shortcoming and Transformation stories, the realisations about shortcomings led to transformation. In Doctor‐patient relationship stories, authors described its importance in theirs and patients' lives, and in System advocacy stories, they described the need for greater advocacy to help change broken systems. Conclusions: Current approaches to teaching the social determinants of health often focus on the role of physicians in recognising and altering social circumstances. However, the realities of practice do not easily allow physicians to do so and, for some, may lead to distress and burnout. There are other ways to cope and make a difference by improving ourselves, investing in getting to know our patients, and advocating. These results can help better support trainees and physicians for the realities of practice. This study revealed four storylines arising from narratives physicians tell about facing social determinants of health. Together, they highlight that the effort of facing things beyond one's control is about self‐improvement, patient connection, and advocacy. [ABSTRACT FROM AUTHOR]
Copyright of Medical Education is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Background: Medical curricula are attempting to prepare trainees to address the social determinants of health, however the life circumstances of patients are often beyond physician control. Little is known about how physicians cope with this dilemma; we sought to examine their perspectives when faced with this challenge to help better prepare trainees for practice. Methods: We undertook a critical analysis of physician narratives from January 2018 to June 2020. In total, 268 physician‐written narrative social determinant of health pieces from four high impact medical journals were screened and 47 met the inclusion criteria and were analysed. Results: We identified four storylines that described the physician experience and strategies for coping with the social determinants of health. While Helplessness stories described authors' experiences of emotional distress when unable to support their patients, the other story types described ways they could make a difference. In Shortcoming and Transformation stories, the realisations about shortcomings led to transformation. In Doctor‐patient relationship stories, authors described its importance in theirs and patients' lives, and in System advocacy stories, they described the need for greater advocacy to help change broken systems. Conclusions: Current approaches to teaching the social determinants of health often focus on the role of physicians in recognising and altering social circumstances. However, the realities of practice do not easily allow physicians to do so and, for some, may lead to distress and burnout. There are other ways to cope and make a difference by improving ourselves, investing in getting to know our patients, and advocating. These results can help better support trainees and physicians for the realities of practice. This study revealed four storylines arising from narratives physicians tell about facing social determinants of health. Together, they highlight that the effort of facing things beyond one's control is about self‐improvement, patient connection, and advocacy. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Medical Education is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/medu.15184
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      – Code: eng
        Text: English
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        PageCount: 14
        StartPage: 1054
    Subjects:
      – SubjectFull: Psychological burnout
        Type: general
      – SubjectFull: Social determinants of health
        Type: general
      – SubjectFull: Hospital medical staff
        Type: general
      – SubjectFull: Attitudes of medical personnel
        Type: general
      – SubjectFull: Physician-patient relations
        Type: general
      – SubjectFull: Work
        Type: general
      – SubjectFull: Physicians' attitudes
        Type: general
      – SubjectFull: Medication errors
        Type: general
      – SubjectFull: Curriculum
        Type: general
      – SubjectFull: Medical care costs
        Type: general
      – SubjectFull: Experiential learning
        Type: general
      – SubjectFull: Emotions
        Type: general
      – SubjectFull: Psychological adaptation
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      – SubjectFull: Medical education
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      – SubjectFull: Psychological distress
        Type: general
      – SubjectFull: Patient safety
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      – TitleFull: From helplessness to transformation: An analysis of clinician narratives about the social determinants of health and their implications for training and practice.
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              M: 11
              Text: Nov2023
              Type: published
              Y: 2023
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