Discussing preventative health strategies with patients has become routine for most physicians. Watch what you eat, get some exercise, stop smoking, etc. But talking about social connection and isolation might not be part of the routine office visit for most physicians, yet it turns out it may be just as critical to preventative medicine as discussing diet.
Dr. Joel Salinas, MD, Assistant Professor of Neurology at Harvard Medical School and neurologist at Massachusetts General Hospital, discussed this with a packed room at the 2019 American Academy of Neurology Annual Meeting. Salinas’ researches social isolation and its effect on health outcomes, and evidence continues to mount regarding the significance of this impact.
Social isolation is associated with increased risk of stroke and dementia, cognitive decline, dementia due to Alzheimer’s disease, and even mortality. Knowing this, it makes sense to understand the factors that indicate social isolation among patients.
First, we need to have a working definition of healthy social relationships. Salinas breaks it down, as it pertains to health, into three dimensions—connection, support, and perception of loneliness.
Connection refers to the network of people in your life. This network is composed of a range of relationships from close family and friends to the mailman or the checker at your grocery store. A very small or non-existent network should be a red flag.
Support refers to the availability of affection or companionship and access to emotional support overall. In addition, access to instrumental support—help with chores and other tasks—is a factor in the support domain. Notably, Salinas’ latest research points to the importance of having one or more listeners in your life as vital to a healthy social life.
Finally, the perception of loneliness refers to the feeling that connection and support are unavailable. This may or may not be an accurate reflection of the situation, but what matters here is the individuals’ perception, as loneliness has its own known health effects.
So knowing that these dimensions make up a patient’s social well-being, and that in turn influences their health outcomes, Dr. Salinas has some suggestions for how this might impact neurologist-patient interactions.
First, he advocates paying closer attention to the social history and going beyond substance use and sexual history. Asking questions like what a typical day is like can help the physician understand the social circumstances for that person. Ask about close confidantes that the patient sees at least monthly. Find out details about immediate family. And finally talk about loneliness.
From there Salinas will help the patient come up with ideas to improve their social connection by discussing hobbies and interests. “I basically take some time to help them debug the issue of social isolation, to see what can be done.” If needed, Salinas will refer to a social worker or provide web resources like AARP for ideas to overcome social isolation. Or he might refer for cognitive behavioral therapy if isolation issues arise from something like social anxiety.
Finally he will write a note to the primary care provider to keep them in the loop and leave the door open for further exploration of these issues.
Salinas emphasizes that this can feel like a lot to add the busy neurologist’s to-do list. “A big part of it is just thinking about things that we would do ourselves when we need social support or need social ties. For us or somebody who is connected it may seem obvious. But for somebody who’s isolated, it may not.” You can coach them on ways to meet new people, or how to discover common ground with a new acquaintance.
To solidify his argument, Salinas says, “There is really great research about physicians who ask these types of questions of their patients, and their overall health outcomes.” Patients whose doctors kept more notes about things such as patient interests and family events had better health outcomes overall.
So next time you talk to a patient about their diet and exercise habits, take a minute to ask about their social relationships. It’s good for your patients, and that extra connection you form might even be good for you, too.