GEP Medicine in Society Guide 2024/25: Social issues in primary care | MyQMUL

GEP Medicine in Society Guide

6. Themed Days - Primary Care

6.3. Social issues in primary care

In preparation, you should have: 

Video on social prescribing

Looked at the World Health Organisation’s (WHO) information about  the social determinants of health and the definition as well as examples of health inequities and their causes.

Looked at some of the public health profiles e.g. the Marmot indicators of the local practice area.

Read NHS England's introductory information on social prescribing or watch the video on social prescribing.

Reviewed communication skills teaching on person-centred interviewing and thought about how you might start a conversation with a patient and what questions you would ask.

Aims 

To introduce you to the social issues that can impact on patients’ health and their response to ill-health, and the role of the health service and other agencies in supporting these patients.

For you to meet your first patient as a medical student, either as an observer or a participant in a patient encounter.

 

Learning outcomes 

By the end of the day you should be able to: 

List some of the social issues that can impact on patient’s health and their experience of healthcare.

Demonstrate an awareness of the importance of considering social factors when treating patients.

Discuss the role of the GP and other members of the primary healthcare team in the support and treatment of patients whose social circumstances impact on their health.

Reflect on your first experience of meeting a patient for the first time as a medical student.

Example timetable 

9.30 – 10.30	Social issues - group discussion. Please review the key learning points from the preparatory work Group brainstorm of social issues; discuss examples  Make links with Day 2’s community area profile  Discuss the role of a social prescriber (possibility to meet & interview)
10.30 – 11.30	Health inequity  Earlier you read about the social determinants of health and health inequity. Watch this video from the research group at QMUL discussing how we can build an equitable primary care. What were the reasons behind inequity and what are some of the solutions discussed? Group decide topic for debate e.g. Are GPs responsible for tackling health inequity? Set up groups for debate.    (includes tea break)
11.30 – 12.15	Students research and prepare for debate in 2 groups.
12.15 – 13.00	Debate
13.00 –13.45	Lunch break
13.45 – 14.15	Prepare for patient encounters  question planning for narrative rather than clinical histories  set up focused observation tasks for observers
14.15 – 15.00	Patient encounters  Patient interviews – either observing healthcare professional or student-led  Role-plays – small groups or fish-bowl set up
15.00 – 15.15	Tea break
15.15 – 16.00	Debrief following patient encounters  Plans/set homework for next session

Suggested Activities 

Tutorial/group discussion based on preparatory reading and student’s knowledge and awareness of social issues that might impact on patient’s health and their experiences of the healthcare system.

Interview with a social prescriber, or other healthcare professional, on their role and experience of social issues that are of particular significance in the practice area.

Join a practice or MDT meeting where complex patients, who often have significant social issues, are discussed.

Prepare to meet their ‘first’ patient - prepare questions, how to begin and end an interview with a patient, discuss dos and don’ts. Interview a real or simulated patient (using role-play) having first gained consent. NB – these patients won’t necessarily have significant social issues.

Observations of different staff-patient interactions; students to look out for consultation skills healthcare professionals use to build rapport and facilitate open communication with patients. Students can also make observations of any social issues that are identified, their possible impact and how these are discussed.

Case studies focussing on the effect of various social issues.

Research organisations providing support for local people with social issues e.g. homeless shelter, cultural centre, refugee support organisation etc. Working in pairs/small groups, students could choose a particular social issue to focus on and conduct their research then present their findings back to group.

 

Questions for you to consider 

Were you surprised at the impact social factors had on the patient you met or discussed? Are these problems the doctor should address?

Is the health service doing enough to make services accessible to people of all social groups e.g. those of different ethnicities, sexualities, homeless people etc?  What do you think could/should be done differently?

If you met a patient today, how did you feel you did when you were interviewing them?  Did you feel the patient felt comfortable talking to you?