Medicine in Society Guide Malta 2021/22: Day 3: Social issues in primary care

Preparatory work

In preparation, students should have:

Looked at the World Health Organisation’s (WHO) information about social determinants of health and their definition and examples of health inequities.
Read the article 'A perfect Storm' written by Dr Jonathon Tomlinson, a GP in Hackney, where he describes the impact poverty and deprivation have on his practice population as part of his blog 'A Better NHS'. And listened to him being interviewed on the ‘Finding Fairhealth’ podcast in which he discusses the effects of coronavirus on people living in deprivation.
Looked at the Fairhealth wiki for further information about vulnerable groups and steps healthcare workers can take to support those most at risk.
Looked at some of the public health profiles e.g. the Marmot indicators of the local practice area.
Completed some reading about social prescribing.
Thought about how they might start a conversation with a patient and what questions they would ask. Considered these suggestions on how to build rapport with patients.

Aims

To introduce students 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 students to meet their 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 students 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 their first experience of meeting a patient for the first time as a medical student.

Example timetable

9.30 – 10.30	Social issues - group discussion 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 inequalities Watch RCGP video (4min) which has suggestions for how GPs can promote health equity and reduce some of the impact of health inequalities during the COVID-19 pandemic. Group decide topic for debate e.g. Are GPs responsible for tackling health inequalities? Is the digitalisation of primary care widening health inequalities? 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 Watch recorded patient interviews
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 virtual 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.
Virtual 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 online research then present their findings back to group.

Questions for students 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?