One day in clinic, recently, I reviewed my daily schedule with the oncology fellows who were working with me that day. With the exception of the new patients on my schedule, I recognized all of the names on my list. I opened the electronic chart of the first patient to skim the problem list, a handy spot where I keep a summary of all the treatments received for the cancer diagnosis.
“Mrs. Jordan* is just here for routine follow up. She completed therapy about three years ago, and she’s done great so far,” I said. I went on to tell them that her son was a physician, but that he never came with her to her appointments. He had emailed, once, just to touch base; but it was clear that his mother valued her independence and wanted be in charge of her own health care. She was in her 80s and very clear about her expectations of me and, I’m certain, of her son.
Using the computer mouse, I pointed to another patient on the list.
“Ms. Finley is coming today to discuss her CT scan from last week,” I said.
I planned to discuss chemotherapy with Ms. Finley, and I was sure she would agree based on the scan results that showed progression of her cancer. I mentioned the regimens I was considering to the fellows, as well as my rationale for my top two choices. I fielded questions about chemotherapy selection in platinum-resistant ovarian cancer versus platinum-sensitive disease.
“She’s retired from teaching,” I told the fellows. “She usually comes with her daughter, who’s a pharmacist.” Keeping busy through volunteer work has been very important to Ms. Finley, and it’s helped to reduce her anxiety about her disease. I hoped she was still doing it. If she had stopped volunteering, it could be an indication of her level of symptoms.
I shifted the mouse and hovered the pointer over the next patient.
“This one is coming for routine follow up,” I said. “She’s usually doing great, except for some arthritis issues. She hasn’t needed treatment for her lymphoma yet. We always talk cooking and food.”
“Ms. Richardson loves good olive oil,” I told the fellows. Ms. Richardson had given me tips on where to buy specialty olive oil locally, and she’s told me how she uses flavored olive oil in her own cooking. She cooks with her grandchildren, and the ability to do this when they visit her means so much to her.
I continued on with my introductions of the day’s patients to the oncology fellows, including a bit about the various diagnoses and treatments and rationale for treatment selection, but even more about who the patient is as a person: what they enjoy, who comes with them to their visits, how they cope with their diagnosis, the type of support they have at home. The information I was giving, I realized, was the social history.
When I was a medical student, I remember learning the value of the social history in discovering unhealthy habits—such as alcohol use, tobacco use, illicit drug use, or a sedentary lifestyle. I learned that the information elicited from a patient during the social history might give insight to the patient’s overall well being, their coping strategies, and their potential for health risks in the future. As a student, I dutifully made note of my patients’ work history, occupational exposure to chemicals, number and type of pets in the home, amount of caffeine intake, exercise habits, seatbelt use, and hobbies. And while my internal medicine attendings seemed to appreciate my thoroughness, my lengthy social history during patient presentations surely evoked some eye rolls from the residents and faculty on my surgery rotations.
Though I once did it because it was a required part of the medical history, the social history has become one of my favorite things about patient care. It is through the social history that I really get to know who my patient is as a person, beyond the label of the cancer diagnosis. Through the social history, I get to know details about my patient’s life that help me to provide more thoughtful care, more humanistic care.
It is through the social history that my patients become more than just patients with a cancer diagnosis. They become people.
*Names and details changed in the interest of protecting patient privacy.