A few days ago, as I was leaving my doctor’s office, I saw an older woman sitting just outside the front glass doors of the medical center, holding her cane in front of her. She looked like she was waiting for a ride. It was a hot day, and she appeared to have been sitting there for a while.
“Are you ok?” I asked her. “Is someone coming to pick you up?”
She looked up at me. “Are you going to the [name of assisted living facility]?” she asked.
“Yes,” I said. “It’s a little off my drive home, but can I give you a lift?”
I introduced myself, we shook hands. She told me her name was Susan.
She admitted she had just spent $6.75 on a cab to get her over to her doctor’s office, and she had no more money on her. I said I’d be happy to drive her home, and we walked slowly to my car.
“Are you on Medicare,” I asked, “or Medicaid?” She said “yes” to both. I asked her if she had ever used Medicaid’s transportation. It did not sound familiar to her. I told her how she could schedule her rides to the doctor in advance, and not have to use her last dime to get there.
Then I asked her how she liked her assisted living facility.
“I want to get out of there,” she said. “I don’t like them. They bullied my husband, and he ended up having a stroke and died. Now I live there alone, and I’m 10 years younger than everyone else.”
“Do you have any family nearby?” I asked.
“I have a son who lives in Brooklyn. I think in Park Slope. No, that’s not right.”
We were at her facility. I helped her out and walked with her to the door. I asked for her name and phone number, wrote them down, and left her with my contact info.
“I’m going to have someone call you tomorrow from a group called LifePath. They’re the local elder service agency. They will use my name when they call, and I’m going to ask them to tell you more about Medicaid transportation, and possible housing options for you. I emailed the office when I got home.
The next day, I was talking to a clinical director at a managed care company about this woman I had met in front of her doctor’s office.
“She had just come from a doctor’s visit,” I said, “and no one in the office had any idea that she had no ride home, or that she was unhappy in her apartment, or that she was angered at the way her husband had been treated. Her inner life came spilling out, because some stranger had asked her a few basic questions.”
This got me thinking about the fact that most doctor’s visits, if they are 15 or 20 minutes long, do not get into what academics call “the social determinants” of the patient’s life. A few basic questions about these social factors should be asked at most visits:
- How are you getting along at home?
- Do you like where you live?
- Do you have many friends there?
- Do you like the food there?
- Are you able to get rides around town pretty easily?
- Do you do your own shopping?
- Do you have any major bills you still owe?
- Are you able to get out and walk a bit?
I have found that people often have a lot to say when asked how they are doing. A question about food leads to a story about their teeth, and how they have not seen a dentist in years, or how they can only eat certain foods. A question about finances leads to an admission that they have very little money left by the end of the month. All these questions lead to the issue of how blue they are feeling today. When we talk about “integrated health,” these questions are as important as any medical condition that brought them to the doctor in the first place.
The medical profession does great things medically. But the social issues that stress and strain their patients go unaddressed, because no one is asking these leading questions. We in the elder home care field are trained to raise these issues – but they should become a standard part of every office visit – unless we want to find our patients sitting out front of our office asking strangers for a ride home.
Al Norman is the executive director of Mass Home Care. He can be reached at firstname.lastname@example.org.