The psychosocial needs of patients can feel overwhelming for a doctor. Our rite of passage as medical students, after all, is anatomy, not sociology. Even now, after a family medicine residency specializing in the biopsychosocial approach to medicine, I still brace myself for surprises before asking routine mental health screening questions of the patients in the community health center where I work on Chicago’s South Side.
"Have you been feeling down or depressed, any loss of pleasure in life in the last two weeks?" I ask all patients. If they say yes, I can ask more questions to possibly diagnose depression, and offer them exercise, counseling or medications. If they say no, then next question. Theoretically.
Frequently, however, a quick psychological screen reveals complex social needs. A typical response goes, "I'm not depressed, doctor, but I am really stressed, my husband just lost his job and I can't get food on the table for the kids"—or “yeah, I’m sad, my mom’s dying of cancer, and now my car’s broke down and I can’t get her to her doctor, I’m real worried about her.”
Thankfully, I don’t need to deal with complex psychosocial needs by myself. I work with a team. As the physician, I’m specialized to look after the biological needs. A group of counselors serves the patients’ psychological needs. And now a dedicated group of college volunteers helps the Chicago Family Health Center serve patients’ social needs.
The college volunteers are part of a national group, now called Health Leads, started in 1996 by a college sophomore at Harvard by the name of Rebecca Onie. She partnered with Dr. Barry Zuckerman, Chief of Pediatrics at Boston Medical Center, to organize college volunteers to man information desks in the lobby of the hospital to link patients to the social services they needed in the community. Project HEALTH, as it was then known, spread to hospitals and health centers in Providence and New York City, then Baltimore, Washington D.C., and Chicago. As of August 2010, about thirty students from the University of Chicago began volunteering four hours each week at a Health Leads Family Help Desk at the Chicago Family Health Center’s South Chicago site.
I love being able to refer patients to Health Leads. When I’m in clinic, and a patient reveals a life on the economic margins, teetering into illness, I have a simple tool to keep them from falling over the edge.
"Would you like to get a call from the Family Help Desk?” I’ll ask them, and explain the program. For the woman with the loss of family income: “They can link you to food pantries, connect your husband with unemployment, help apply for Medicaid, help you apply for help paying for electricity, and connect you with job training programs.”
For the family with no car: “They can connect you with medical transportation services.”
For the illiterate grandmother wanting to learn to read so she can read with her grandchildren: “They can connect you with literacy programs.”
If the patient is amenable, I refer them to Health Leads, and the college volunteers take it from there.
With college volunteers looking after routine needs, our clinic’s sole social worker is able to focus on more psychologically demanding cases, such as domestic violence and substance abuse.
As a family physician, my role is to identify and respond to the most common health needs in the community, taking care of them on my own if I can, or referring the patients to specialists to care for their health problems if need be. When it comes to social needs, I don't need to memorize all the community resources. I just need to identify patients’ needs and refer them to Health Leads to be connected to the resources they need. The Health Leads college volunteers are my social service specialists, partners in the quest to create a healthier America.