Social History

The social history is an interesting phenomenon. Most practitioners will ask about health-related behaviors such as drinking, smoking, and drugs. Even more detailed practitioners may ask about diet and exercise. But the social history also encompasses things such as marital status, profession, occupational exposures, life at home, etc.

When we first begin as medical students, the social history comes naturally to us. It is simply getting to know a person. We ask where they grew up, how they ended up in the Bay Area, what they do for work, how many kids they have, whether they have pets, what social support they have. It's fun and with the luxury of time afforded to a medical student, it's a natural thing to do. When we become interns and residents, the social history gets severely truncated. Our time is a premium and the social history rarely leads to diagnoses. As an intern, I ask where someone lives and who they live with, but only to understand discharge planning and needs. Occasionally I ask about social support for those who have a new diagnosis of a serious condition. But I omit the richness I once gathered as a medical student. Talking to attendings, though, the social history regains its place. Attendings have interns and residents to poke through the nitty-gritty, and they are able to focus on the patient as a whole person again. I've had multiple attendings who simply chat to patients about their life experiences.

I would never discount the importance of social history. Understanding the whole person is fundamental to building a sound therapeutic relationship. But it's hard to maintain that now when I am bombarded with too much information and too many things to do. Striking that balance between efficiency and patient-centered care is something to work on this year.