Last month, a viral video explaining an MIT neurosurgeon’s decision to quit the field unearthed the many frustrations that millions of fellow medical professionals have been facing for years.
The most obvious is burnout. One survey found more than half of U.S. doctors experience burnout, and that numbers were highest among doctors in emergency medicine, internal medicine, ob/gyn, and family medicine. Another study weighing physician guidelines with current patient demands suggests it would take primary care doctors 26.7 hours per day to see an average number of patients.
Recent pleas diagnose the culprit as moral injury — described, in another viral essay, as a phenomenon in which health workers are forced to cast their ethics aside, and put the hospital’s business needs over their patients’ needs. During the pandemic, eight in 10 doctors experienced moral distress, according to one survey, and another article suggested more than 70% of emergency physicians agreed: “the corporatization of their field has had a negative or strongly negative impact on the quality of care and on their own job satisfaction.”
But beneath the surface of burnout and moral injury, something else is happening in medicine: a phenomenon in which doctors, strained for time and resources, often can’t treat the root causes of their patients’ suffering.
The MIT neurosurgeon compares this phenomenon in his patients to fixing a house with a leak in the roof. Just as tearing out the moldy drywall and installing a brand new wall does little to stop the underlying leak, cutting out bulging discs and installing titanium spine rods does little to treat what’s often the root cause of the patient’s pain. Regardless of the surgeries he can perform, the doctor says the patients who best recovered were the ones who had healthy lifestyles, stress coping mechanisms, and good social support.
Which begs the question: why can’t doctors prescribe those medicines, too? Why can’t prescriptions include activities that help patients find ways to cope with stress, move their bodies, spend time outdoors, and find deep and lasting relationships?
Around the world and in the U.S., more health workers are mobilizing around this mission through a rapidly spreading practice called social prescribing — a practice through which health workers refer patients to nonmedical resources or activities that aim to improve their health and strengthen their community connections. Instead of asking “what’s the matter with you?” social prescribing asks patients to consider “what matters to you?” and invites medical professionals to help them get there.
The practice responds to a basic fact: Up to 80% of our health is determined by the environments in which we live (social determinants). To survive, we need basic resources — clean air, trees, nutritious food, shelter, and money. And to thrive, we need sources of joy, meaning, and relationships — reasons to wake up in the morning, things that make us feel healthy, connections to what matters to us.
And so, by prescribing patients activities like cycling groups and art classes, and resources like food, legal support, and transportation, social prescriptions help patients meet these basic and psychological needs — improving their ability to manage their own health problems and boost health outcomes across the board.
The practice began in the U.K., the world’s first nation to create a minister of loneliness, an issue made more dire after the National Health Service estimated one in five doctors’ appointments are made for nonmedical, purely social reasons. This creates more pressure on doctors, who then have less time to see patients with medical issues, in a system already struggling with staff shortages, long backlogs, and pervasive burnout.
And so, to free up doctors’ time, social prescribing is often done with the support of someone like a link worker — health professionals whose job is to listen to the patient, understand what matters to them, and connect them to community activities and resources accordingly.
“I find amazing organizations not because I look on Google, but because I walk around my neighborhood, and understand who’s in the community.” says Gay Palmer, one of the U.K.’s first link workers. In other countries, the link worker role is handled by social workers, health coaches, or even volunteers.
“There’s a lot of tears and frustrations being pulled out [in that first conversation], so all I’ve got to do is listen, translate for the [doctors] what’s going on, and help them understand why [the patient] has had these frequent attendances,” Gay says.
This sort of translating and redirecting has proven to be effective; studies associate social prescribing with a reduction in the total number of doctor visits and emergency department visits, hospitalizations, and healthcare spending — all of which alleviates pressure on the system.
It’s no wonder surveys have found a majority (59%) of general practitioners in the U.K. believe social prescribing can reduce their workload.
And yet, more than just giving doctors more time to focus on patients with clinical needs, social prescribing can help remind doctors of their own needs, and reasons for practicing medicine in the first place.
That was true for Ardeshir Hashmi, MD, the endowed chair for Geriatric Innovation at Cleveland Clinic, and one of the first adopters of social prescribing in the U.S. His first go at social prescribing came when he was at Massachusetts General Hospital, where he met “Ruth,” a 93-year-old patient who came to the emergency department every 2 weeks with chest pains.
“Everyone thought, ‘Oh my god, it’s something with her heart, her blood vessels,'” he explains. But when Hashmi learned her chest pains were gone by the time she arrived at the hospital, he also learned the root cause of her pain: she was lonely.
Her grandson — her main social support and ride to ballroom dance lessons — had left for college. The solution? Arranging for a geriatric case manager to take her to ballroom dancing again.
“Wouldn’t you know it, all of these emergency department visits disappeared! It was just as simple as that.”
When Hashmi arrived at the Cleveland Clinic, he became determined to make that kind of socially determined, patient-led care the norm. He established a patient council, which recommended clinicians invest in 90-minute conversations with patients, and “prescriptions” based on those conversations. Then, with community partners and a software platform, clinicians prescribe local connections, like walks at the local arboretum or home visits through an art center.
The result has been hundreds more patient stories like Ruth’s, Hashmi says. And yet, he believes the benefits aren’t just for patients; they’re also for healthcare professionals.
To remind him of the value social prescribing can hold, Hashmi keeps the card Ruth’s kids sent him on his desk, with an encouraging message: “Thank you for giving us our mom back.”
Julia Hotz is a solutions-focused journalist based in New York. Her stories have appeared in The New York Times, WIRED, Scientific American, The Boston Globe, Time, and more. She helps other journalists report on the big new ideas changing the world at the Solutions Journalism Network. Hotz is the author of The Connection Cure, published by Simon & Schuster, from which this piece was excerpted.
Please enable JavaScript to view the