Posted: April 24th, 2025

SDOH

Overview

Factors such as income, transportation, cultural norms and preferences, language barriers, education, family dynamics, etc., all interplay with every health encounter and will help determine what is desirable and possible for a patient. 

So often in practice, we come across patients not adhering to the treatment plan. Whether it’s the patient not following-up, showing up, taking medications as prescribed, completing labs, or not being disciplined enough to practice healthy habits, it’s far too easy to blame the patient and label him/her as “non-compliant.” However, is the patient really non-compliant? Is it fair and appropriate (or even ethical) for clinicians to make this judgment? There’s almost always a logical and more compassionate reason to explain the patient’s circumstance, and it’s often attributed to social determinants of health (SDOH) and inequities.

Your role as the provider is to listen to your patient and help determine what is desirable and what is possible. 

If a patient is not interested in changing (no matter how much you perceive that they need to change), they will not change. This is true no matter how “urgent” the behavior change may be. If we make recommendations that don’t match our patient’s desires or are impractical for them to achieve, we are actually harming them by wasting their time and resources, diminishing the therapeutic relationship by not listening to them, and providing culturally unsafe care.

Therefore, as providers, we need to train ourselves to become cognizant of how the social determinants of health impact our patients’ lives to make meaningful recommendations and provide the best care. 

It is also important to remember that we provide care with our unique “lens” on, just as our patient comes to us with their unique “lens.” We will have “blind spots” when we consider how the social determinants of health impact our patients because our “lenses” are different since our life experiences are almost certainly different from theirs. Therefore, we will not even consider some primary things for our patients. 

Ultimately, the point is that there are so many factors to consider, and we will be blind to key components of our patient’s lives and experiences because they are not visible to us and because our “lens” only shows us what we know.

Unless we make the effort to move beyond the limits of our lens, by being open-minded, respectful, and inquisitive. 

Assignment Instructions

1. Complete the SDOH Reflective Practice WorksheetDownload SDOH Reflective Practice WorksheetOpen this document with ReadSpeaker docReader

   Columns 4 and 5: reflect and identify your SDOH facilitators and barriers (states of privilege)
   Please type your answers succinctly into the template provided. Calibri, Times New Roman, or Arial fonts are the easiest to read. 

2. Underneath the table, complete the two self-reflection prompts

Module 4 SDOH: Reflective Practice Worksheet

Self-Reflection:

· Answer these two questions:

· Reflect upon the differences between your patient and your SDOH facilitators and barriers. Where are your blind spots and what are your biases in this case? What role do your particular “privileges” have in this situation?

· How would you approach making recommendations with this patient, given their SDOH facilitators and barriers? Consider upstream, midstream, and downstream strategies – list at least two for each category.

Rev. 5/24