JAMA Viewpoint: Garg, Boynton-Jarrett Propose a Better Way of Using Social Determinants of Health

Screening for social determinants of health (such as housing, education, and employment status) is becoming an essential part of medical encounters. However, unlike traditional medical screening, where there are clearly outlined algorithms and diagnostic tools, screening for determinants of health can be less straightforward and may have unintended consequences.

Lto r: Arvin Garg, Renée Boynton-Jarrett
Lto r: Arvin Garg, Renée Boynton-Jarrett

In a June 27 JAMA Viewpoint, Associate Professors of Pediatrics Arvin Garg, MD, MPH, and Renée Boynton-Jarrett, MD, ScD, co-author an opinion piece on the potential harms of screening for social determinants of health, and propose five key principles that practitioners can use to maximize the benefit and minimize the unintended consequences of such screening. 

The BUSM faculty, together with Paul H. Dworkin, MD, Chair and Professor of Pediatrics, University of Connecticut School of Medicine, explain that, “Screening for social determinants can detect adverse exposures and conditions that typically require resources well beyond the scope of clinical care. Screening for any condition in isolation without the capacity to ensure referral and linkage to appropriate treatment is ineffective and, arguably, unethical. Such screening could yield expectations that, if unfulfilled, could lead to frustration for patients and physicians alike, and could erode the patient-physician relationship.”

Among the five key principles that could significantly improve the health and well-being of patients while minimizing unintended harm, they propose that screening should involve shared decision-making with the patient, and should be conducted within a system that supports linkage to a wide array of community-based services. Further, they advise practitioners to engage their entire practice population rather than specific subgroups targeted based on their apparent social status, and to use a strength-based approach to support patients and their families.

Read the entire article at JAMA Viewpoint

Submitted by: Elie Sader, MD