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Perspective Comparison Regarding the Importance of Social History, Empathy, and Their Role in Osteopathic Distinction
Harp, E. [4]
Wood, E. [2]

Journal: Journal of Osteopathic Medicine Date: 2024/12, 124(12):Pages: A45-A47. doi: Subito , type of study: cross sectional study

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2024-2000/html)

Keywords:

cross sectional study [820]
distinctiveness [15]
empathy [59]
social history [1]

Abstract:

Context: Social history continues to be a developing subject of discussion in medical education. Calls for improvement are driven by increased awareness of social determinants in health and wellness and focus on patient-centered care. Social history offers an opportunity to demonstrate both the osteopathic principle of whole person care and empathy. Both are essential to osteopathic distinctiveness. Empathy, however, has been shown to wane as training progresses. Improving skills in social history-taking can hope to reduce this decline. While satisfaction of the osteopathic principles and practice core competency is typically direct with osteopathic manipulative treatment, development into other curriculum areas continues to be a challenge. The social history offers such an opportunity. Studies have shown that both patient-centered social risk screening and conveyance of empathy can strengthen patient and provider relationships. Despite increased awareness of the importance of social history, challenges both to approaching and obtaining remain. Contributions to this challenge include expansion of included topics, temporal limitations, and insecurity in approaching less tangible subjects in a patient visit. In addition, potential differences in perspective regarding social history may exist between patients and providers. Studies have compared perspectives, identified challenges, and offered strategies to improve the social health integration. Few studies, however, address this from an osteopathic perspective. Recognition of challenges related to social history and its relationship to the osteopathic principle of body, mind, and spiritual unity from both student and patient perspectives can identify targets for improvement in our educational programs. Insight to improve alignment between patient and provider perspectives is additionally gained. Objective: Assess responses to questions related to empathy, social history, and their relationship to the osteopathic approach. Questions aim to identify challenges and perspectives regarding social history, empathy, and the osteopathic philosophy. Information from both students and a patient-representing group is gathered. Potential differences between students enrolled in the Doctor of Osteopathic medicine (DO) and Master of Science of physician assistant studies (PA) are also explored. Information from student learners can provide opportunities to improve education and training and offer better alignment between patient and provider perspectives. Methods: Surveys were created to address social history, empathy, and the triune osteopathic approach. Both multiple choice and Likert scale assessment questions were used. Multiple choice questions identify challenges to acquiring social history, where empathy is most significant in the interview process, and the medical significance of certain social health determinants. The Likert scale was used to assess responses to statements regarding the role of social history concerning the first osteopathic tenet and overall health and wellness, role of empathy, and contribution to trust in the provider-patient relationship. Assessment questions emphasize the first osteopathic tenet also articulated in the osteopathic core competencies. Chosen domains represent a combination of the primary author’s experience as an osteopathic physician educator, published goals of education in the osteopathic tradition, and current trends and challenges in social history taking. Three total groups were queried including second year DO students, second year PA students, and non-clinical staff at Oklahoma State University-Center for Health Sciences. The latter group represents the patient-perspective group. The patient-perspective survey included slight differences in question, but responses stayed the same. All students had comparable levels of medical education experience, recently completing one year of their respective curriculum. After a brief oral presentation, both student and patient groups were provided with the respective surveys to be completed anonymously and independently. Social and academic desirability was minimized by optimizing anonymity. Returned paper surveys were kept in three separate groups, results manually transcribed, aggregated, and analyzed using Excel. Results: A total of 60 (n=60) surveys were returned completed (100% response). No consensus among students was identified as the most difficult social health determinant to discuss with patients, while the patient group felt emotional and spiritual wellness was the most challenging (45%). All three groups indicated a systematic approach at the initial visit to be the most effective method to obtain social history (58%). All three groups identified the chief complaint as the most important area of the patient visit to convey empathy (42%) followed by physical examination, the latter with more patient than student respondents (35% vs 15% PA and 0% DO). 15% of total indicated social history as the most crucial interview section to convey empathy. All three groups identified healthcare access and utilization as the most medically imperative social health determinant (50%). A higher percentage of PA over DO students indicated substance use as medically imperative (45% vs 20%). No consensus identified the social history interviewing aspect with which providers most struggle. 5-point Likert scale median and mean response to statements regarding empathy and osteopathic principles in social history was positive. The patient group showed a more favorable response than students regarding social history representing the osteopathic principle of body, mind, and spirit (mean 4.15/5 vs DO 2/5, PA 3/5). All groups agreed social history provides an opportunity to address physical, emotional, and spiritual wellbeing (means: PA 4.05/5, DO 4.05/5, patients 4.25/5) and can fortify trust in the relationship (means: PA 4.4/5, DO 4.45/5, patients 4.1/5). Both student groups showed a more favorable response than the patient group regarding social history being essential to health and wellness (means: DO 4.7/5, PA 4.5/5, patients 3.85/5). Student groups agreed that word choice during the social history interview is critical to the relationship (means: PA 4.45/5, DO 4.2) while the patient group was short of agreement (mean 3.9/5). Conclusion: Responses support the importance of social history to health and wellness and a way to demonstrate the osteopathic principle of body, mind, and spiritual unity. Healthcare access and utilization stood out as the most medically imperative social health determinant. The chief complaint was highlighted as the most important temporal location to demonstrate empathy, with social history indicated as less significant. Patients indicated spiritual and emotional health as the most difficult to discuss indicating a need for improvement of our learners to address these foundational aspects of the osteopathic approach. The lack of agreement where providers most struggle in obtaining the social history supports continued efforts to improve all aspects of interviewing skills. Findings are limited by sample size (12% of typical DO class, 20 of 165; 80% of typical PA class, 20 of 25), inherent limitations of Likert-type scales, homogeneity of student subjects, and use of a surrogate patient group (non-clinical staff). The latter, however, provided an opportunity for controlled comparison of perspectives.

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