Beyond the Surface: Addressing the Hidden Determinants of Health

As we commemorate Pharmacy Week, we at UpStream would like to share an enlightening tale that exemplifies the essence of our mission, emphasizing the significance of addressing not just the obvious but the covert Social Determinants of Health (SDOH). 

A recent encounter with a patient at our clinic serves as a poignant reminder of the multifaceted nature of healthcare. While his lab results seemed optimal and his overall health appeared stable, a deeper dive unveiled challenges seldom discussed but critical for patient care. 

Upon delving into his apprehensions, it was revealed that the patient was battling illiteracy. This was not a reflection of an oversight on the part of his primary care provider; such personal details are not usually a part of routine questions. Yet, this discovery was instrumental. It underscored the need to explore beyond conventional healthcare queries and recognize the potential hidden challenges patients may be grappling with. 

Illiteracy was just one facet. This patient's difficulty in understanding medication instructions had led to inconsistencies in his dosages. It emphasized the importance of tailored approaches, such as the pictogram medication chart introduced to assist him. 

However, the spectrum of SDOH is vast. Beyond literacy, factors like: 

1. Transportation: Do patients have reliable transportation to attend regular check-ups? 
2. Nutrition: Are they getting adequate nutrition, or do food deserts limit their options? 
3. Housing: Is their living environment conducive to maintaining good health? 
4. Mental Health: Are emotional and psychological challenges being addressed? 

All these and more play a role in the overall well-being of a patient. 

Our patient's journey underscores the critical importance of holistic healthcare, which considers both overt and covert challenges. In the evolving landscape of healthcare, providers are encouraged to integrate these considerations into their approach, ensuring that care is not just symptomatic but comprehensive. 

This story serves as a beacon, urging us to consider the myriad of factors influencing patient health. It is an invitation for thought leadership in healthcare to be more encompassing, recognizing and addressing the various SDOH that can sometimes remain in the shadows. 

Special thanks to Lori Wesson von der Fuhr, Pharm.D., CDCES, CPP , for her valuable insights and contribution to our understanding.