Social medicine: Using the social life of patients to manage diseases

Truth be told, physicians have little control of which way disease management will go once patients exit the clinic. Effective chronic disease management relies heavily on the patient’s motivation and perseverance. 

Furthermore, patients are not held accountable for their health behaviours, and a three-monthly follow-up is too infrequent to alter health habits. 
 

As social beings, behaviour is contagious

A recent study published in the New England Journal of Medicine points out that tapping into patients’ social relationships can be more effective in improving health and encouraging healthy habits than increasing interactions with healthcare professionals. 

"Spouses and friends are more likely to be around patients when they are making decisions that affect their health -- like taking a walk versus watching TV, or what to order at a restaurant. Patients are also more likely to adopt healthy behaviours -- like going to the gym -- when they can go with a friend," explains co-author David Asch, director of the Penn Medicine Center for Health Care Innovation.

The authors pointed out another study where diabetic patients who had weekly conversations with peers had a more significant decline in glycated haemoglobin levels than patients who worked with clinical staff. 

"Although we don't normally think of competition or collaboration among patients are part of managing chronic diseases like high blood pressure, heart failure, or diabetes, research shows that behaviour is contagious, and programs that take advantage of these naturally occurring relationships can be very effective," said co-author Roy Rosin, chief innovation officer at Penn Medicine.
 

Social engagement strategies

The study’s authors introduced a five-step ladder with escalating rungs of social support to help physicians effectively formulate social engagement strategies that promote health.

The ladder ranges from activities with no social engagement – such as taking medication – to activities that incorporate peer support or reputational incentives to hold patients accountable for their health behaviours. 

Some of these strategies include encouraging patients to go to the gym with their friends, or prescribing weekly phone conversations with fellow patients to share advice. 

"Sure, health care is serious business," Asch says, "but who says it can't be social?"
 

Social medicine remains an untapped resource

Despite its clear, cost-effective benefits, doctors rarely utilise social medicine in disease management. 

“Concerns about privacy are often the reason doctors and hospitals avoid organising social support. But while privacy is very important to some patients under some circumstances, more often patients would love if their friends and family helped them manage their diabetes, and those friends and family want to help people get their health under control,” Asch said.

"Though people are more heavily influenced by those around them every day than they are by doctors and nurses they interact with only occasionally, these cost-free interactions remain largely untapped when engineering social incentives for health. That's a missed opportunity,” adds Asch. 

Sources: MIMS
https://www.sciencedaily.com/releases/2016/12/161229113444.htm
http://globalnews.ca/news/3156254/social-medicine-how-doctors-are-working-family-friends-into-patients-recovery/