The Social History & Patient Satisfaction.

Written by: Peter Paganussi, M.D., FACEP
 
               One way to accomplish two Emergency Medicine “tasks” at once is during the Social History or the PFSH (Past Medical, Family & Social History) portion of the History and Physical during the initial patient encounter. We are required to document a minimum of one specific item from any of the three components of the PFSH. A review of two or three of the PFSH components may be additionally required as the category of EM service rises.
               Three items included in the Social History are perfect fodder for engaging patients and increasing patient satisfaction.

These items are:
1)    Current Employment
2)    Occupational History
3)    Level of education
 
I almost always ask patients what they do for a living. This gives me an idea of the “world” I am sending them back to and how todays encounter might impact or change that. For example sending back an IT Specialist with an ankle sprain versus say a Construction worker or a Power-line Repairman. But also it can sometimes tell me a lot about the person I am caring for.  I also sometimes include hobbies because some can be very pertinent to the reason for this visit. Like an injury sustained while “free climbing”. Maybe the IT Specialist does this in her spare time. This insight allows me to better know whom I am caring for. I have found it very helpful over the years.
 
It can be a brief digression into making someone happy. People usually like to talk about what they do/did either for a living or what they do for fun. It is a pleasant way of drawing out the patient and establishing a bond with them. In the greater Washington, DC area you meet some awfully interesting people who do fascinating things. In particular, retired individuals often enjoy when you ask them what they did for a living. Retired military with amazing stories of their lives during war and peace. The physicist who works for NASA and helped develop the flotation device for the Apollo spacecraft. Or the former Judge who worked on the Watergate case. They are no longer just an old man or an old woman; they are the former Congressional Assistant or former HS Principle, former Sheriff’s Deputy etc.
 
It only takes a moment, it gets you more than enough for the PFSH, and most patients enjoy becoming a person in the doctor’s eye and not just a diagnosis. As far a Level of Education I might ask the Judge where he went to Law School, or where the Physicist got her degree. Sometimes you share an alma mater and this further creates a positive connection that can only enhance the experience for the patient.
 
When you are a patient, the last thing you want is to be treated like a “number”, or “the kidney-stone in Bed 3”, or worst of all “a piece of meat”. By gently asking a bit about what they do “humanizes” them. It shows you are interested in who they are and not just their particular malady. Sometimes it can actually provide important clues to the actual diagnosis as well.
 
Thus you have garnered Coding information for our Billing Department, while at the very same time establishing a very important connection with the patient. You have let the patient know that who they are is important to you.