Avoiding the Hazards of "Snapshot Care" Across Disciplines, from Social Work to Nursing

Faculty and students at the USC Suzanne Dworak-Peck School of Social Work must continually grapple with a challenging question: will treatment be more or less effective for patients depending on their social or cultural background?

For National Interprofessional Health Care Month, which celebrates the positive impact of collaboration across health care disciplines during April, we set out to explore this question within the contexts of both social work and nursing. Ellen Olshansky, professor and chair, and Sharon O’Neill, clinical associate professor and vice chair of the Department of Nursing, spoke with us about how the USC Suzanne Dworak-Peck School of Social Work takes the social determinants that affect patients’ health into consideration in order to ensure they receive the best treatment possible.

USC Suzanne Dworak-Peck School of Social Work: Haluk Soydan, associate dean of faculty affairs and senior fellow for global research impact, has said: “You have a program or intervention that works somewhere; the question is how do you ensure that same intervention works in other settings, in other cultural and social environments?” What does this mean in your work?

Ellen Olshansky: What this means to me is that we need to be culturally competent and sensitive, and realize that an intervention for one person or group may not be the same as may be required by a group coming from another cultural perspective. When I talk about the environment and social determinants of health, it is a matter of recognizing that people have very different life experiences based on many variables including where they live, socioeconomic status, and ethnicity. We have to take all of that into account, not only in providing health care, but also in understanding how people experience health and health care.

Sharon O’Neill: I agree. Physicians are often prescriptive, telling the patient what to do and how to do it without taking into account factors that impact the patient’s ability or desire to succeed — such as his or her income, ability to find housing, or responsibility to take care of a family. It can be hard to choose between paying for medication and paying for rent, but we take these things for granted if we don’t have to deal with them in our own lives.

USC: Can you think of any scenarios in which an incomplete consideration of external factors would have a negative effect on a patient’s recovery?

SO: I’ve seen several situations where a patient needed a particular medication to treat a chronic illness, but the cost of the copays prior to the Affordable Care Act was prohibitive. I have also seen situations where a patient was denied coverage because of a preexisting medical condition, or because they had to spend down a certain amount of their assets in order to qualify for benefits under a public program, especially at the start of a new year. They could have been fine in December, but in January they were forced to spend down their assets. Factors like this have a huge impact on a patient’s decision to pursue treatment, because they have to figure out how they’ll come up with money to feed their families, too. Even transportation issues can impact a patient’s ability to access and maintain care. The cost of transportation isn’t covered by any public program.

EO: That’s a great example. I am thinking more theoretically. The idea of “snapshot care” - or the notion that in a clinic or hospital the health care provider, be it a nurse practitioner or physician, only sees a snapshot of the patient - means that they are not then aware of the patient’s life circumstances

A clinician could be treating a patient for a cough and, without hesitation, may give the patient a prescription for cough syrup or antibiotics for bronchitis and send them on their way. But what if the patient is homeless, or has a lot of social concerns that are going to impact their ability to fill this prescription? There is way more going on with the average patient than what can be gathered from a brief encounter with a health care provider, and we need to be aware of those extenuating factors in order to deliver better care.

USC: With all of these factors at play that aren’t immediately obvious, how does a multidisciplinary approach help you to address the diverse needs of a patient?

EO: With a true interprofessional approach, we are able to connect patients to many different people, from social workers to nutritionists and dietitians, who could in turn connect them with the care that they need. In other words, if we really have interprofessional care, patients will get comprehensive care that goes beyond just a snapshot.

SO: In a true interprofessional model, one provider on the team may certainly lead the rest of the team, depending on the issues that they’re addressing. For example, if a patient has physical limitations, we would have a physical therapist speak with the patient first and report their findings to the rest of the team. Then the team can take a more informed approach to working with the patient. In turn, the patient — who really is the primary person in charge of his or her health care — will have a more productive life.