Teaching Learners to Care for Marginalized Patients

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Summary:

Family physicians care for people from all walks of life. In a thoughtful study of primary care strategies to engage low-income patients, the first article provides 3 strategies to enhance both the practice and teaching of socially competent care. Adjustments in the usual process of care are needed for patients who are marginalized or poor. Preceptors can support learners in screening for poverty (CEP Poverty Tool), using a structured social history when relevant (IF-IT-HELPS mnemonic) and modifying the clinical encounter.  Trust and rapport must be built.  Most prevention and screening guidelines are based on populations that do not include the poor or marginalized; modify the approach to suit the patient. The 1-minute preceptor model has been adapted for teaching social determinants of health (SDOH), as one way for preceptors to help move learners from acknowledging and empathizing with SDOH to activation and engagement.

Take-Away Tidbits:

  1. Identify patients who are marginalized and vulnerable
    a. Quick screen: “Do you ever have difficulty making ends meet at the end of the month?” (CEP Poverty Tool)
    b. Social History via IF-IT-HELPS mnemonic
  2. Engage:
    1. Build a personal connection to overcome social distance
    1. Align physicians’ expectations with patients’ social vulnerability
    1. Work collaboratively with other professionals to empower patients
  3. Recognize when prevention and screening guidelines do not apply
  4. Incorporate: teach in-clinic using SDOH-Themed One Minute Preceptor

Links to Resources:

Loignon C, Fortin M, Bedos C, et al. Providing care to vulnerable populations: a qualitative study among GPs working in deprived areas in Montreal, Canada. Fam Pract. 2015;32(2):232-236. doi:10.1093/fampra/cmu094

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4371892/

Centre for Effective Practice (November 2016). Poverty: A Clinical Tool For Primary Care Providers. Toronto: Centre for Effective Practice.

https://cep.health/media/uploaded/CEP_Poverty_Tool_ON_2016.pdf

A Social History Tool using the IF-IT-HELPS mnemonic

https://cep.health/download-file/1542915867.061284-96/

Cacace, F. (2020). Application of One Minute Preceptor to Teaching the Social Determinants of Health. In SGIM FORUM (Vol. 43, No. 4).

https://www.sgim.org/File%20Library/SGIM/Resource%20Library/Forum/2020/SGIM-APR-4.pdf