There are two things I love about being a General Internist: 1) caring for families, and 2) taking a detailed social history. Why? The short answer is that it’s FUN. There is something about taking care of families that feels like home. There is not just a relational benefit, but a healthcare benefit on both sides of the stethoscope. Caring for families is as close as we can get in medicine to truly understanding how one’s living situation affects their experience of illness, i.e., the social determinants of their health.
What is the significance of the social determinant of health? Understanding this concept helps us separate the illness from the disease. Disease is the word that we give to describe the parts of the body that are not functioning normally. It is typically defined by certain signs and symptoms. Illness, on the other hand, is the patient’s experience of their disease. Illness is abstract and can be best understood in a broader context of someone’s lived experience, while disease is more linear. Disease can be listed in a textbook, whereas illness is better described through storytelling, from the human source. When we develop an understanding of the social dynamics that influence the health of our patients, we deliver better care. In addition, there is the emotional benefit. I cannot underscore how meaningful it is to be trusted with the personal challenges and joys of total strangers. There is no other profession outside of healthcare where trust is so central.
The Martins* are your typical American mid-size family. They include the parents, two of their adult daughters with their spouses, and their adult children. The Martins are a fun-loving, wholesome family. They are highly successful in many aspects of life. The patriarch, whom I will call John, is retired military. He is driven, disciplined, and jovial. His personality is indicative of how he treats his Type II Diabetes. He runs regularly, despite his low back pain. He adjusts his carbs in moderation. His laugh is contagious. The matriarch, Joan* is a woman in charge. She is strong, intelligent, hypertensive, and a bit cheeky. She jokes with a twinkle in her eyes that makes me smile and shake my head at the same time. She always asks me how I am doing. She asks about my family at every visit and genuinely wants to know. She worries about me. We have gotten her blood pressure management down to a science. It is lower in the spring and summer when she can love on her vegetable garden. As people of color born in the 50s in the south, they have navigated life on the receiving end of systematic exclusion. Despite these challenges, they have thrived. They don’t dwell on the hardship, but comments will occasionally escape that give me a glimpse into their family life history. As a first-generation Asian-American who benefited from the activism of
their predecessors, I don’t take that for granted. They would rather focus on the joys of life, but the inherited and lived anxieties of being Black in the south are never far away. Within the safe confines of my clinic room, when I step back from the EMR, they will allow me a glimpse into their day-to-day life.
Their two daughters are around my age. We grew up going to rival high schools and connected through our shared histories of growing up in the 80s. The older sister faces some serious health challenges and has approached them all with grace and honesty. When she fails, she shares her frustration, sheds a few tears, and then gets right back up. She is a fighter. The younger daughter and her husband come to all their clinic visits together. They compete, joke about each other’s taste in clothes, and laugh through it all.
The Martin family bonds are strong. They are a family that shares a deep sense of faith. They worry about each other. They help each other. The whole family, including the two sons-in-law, seem to enjoy each other’s company. All six of them prefer to schedule their appointments with me on the same day, with two goals in mind: 1) They all fast for labs and then go out to brunch together. 2) They trash-talk each other across the clinic rooms. They are boisterous. Sometimes, they will knock on shared walls. They will poke their heads out of the doors and make jabs at each other while waiting for me. They will compete over blood pressure numbers across the hall. I will readily admit that I have found myself wanting to be invited to their family brunch.
In addition to laughing a lot when they come for their appointments, their interactions are information for me. Their tight family bonds give them strength and they support each other through their illnesses in a way that some other families don’t. They cook for each other, grow vegetables for each other, and work out together. They push each other for the better and I strongly believe this improves their health outcomes.
And their laughter? It’s contagious – it comes deep from their bellies, as if to remind the world that they indeed take up space. In a modern world where loneliness is an epidemic, their togetherness is a triumph. Their love and joy is an act of resistance.