Patients’ Social Problems – a Survey in Family Practices
DOI: 10.3238/zfa.2014.0496-0501german translation / full article
Background: Patients suffering from psychic disorders on account of social problems are sometimes motivated to see their family practitioner (FP) . FPs consider these problems in their daily work, but medical care alone can hardly solve social problems if they are not caused by a disease. There is little evidence about number and kind of such patients’ social, not disease-triggered problems. The present survey aims to record and quantify social problems in German family practices.
Methods: Structured and participant observation (SPO): 45 FPs in this survey took part in the precisely planned observation as observers. They were asked to provide a written record after each of a maximum of 40 consecutive consultations stating whether and which social but not disease-triggered problems have occurred and how time-consuming they have been.
Results: 1706 patient consultations were recorded. 256 (14.4 %) of them focused on social problems. In line with the categories of the International Classification of Primary Care (ICPC), social problems included the following: conflict at the patient’s place of work or education in 63 cases (25.6 %), family or personal relationship problems in 54 cases (21.9 %), death or illness of a partner in 27 cases (10.9 %). Less than 10 % of each of all cases were related to insurance and other legal matters, social and cultural life, food, housing, neighborhood or financial difficulties. In 36 cases (14.6 %), individual problems of daily life could not be categorized. In almost one third of the cases, social problems took up more than half of the patient consultation time.
Conclusions: As more patients need advice and help with social problems, it is important for FPs to have an enhanced awareness and specific expertise in this area. A medicalization of such problems must be seen critically. Realistic help and support can be better given by specialized social help desks. The more FPs know about relevant social services, charities and companies in town, the better they are able to assign a patient or to arrange an appointment. It is therefore particularly helpful not only to know the addresses and opening times of the local social help services, but also to be able to name advisers working there. Thus, FPs would follow their task of „coordinating and integrating“ as described by the working-definition of the German College of General Practititioners and Family Physicians (DEGAM).