Social and Behavioral Issues in Medicine
Sequence Directors

Arno Kumagai, M.D.
Associate Professor of Internal Medicine
Email: akumagai@umich.edu

Eric Skye, M.D
Assistant Professor of Family Medicine
Email: eskye@umich.edu

Sequence Description

The overall goal of the Social and Behavioral Issues in Medicine course, which consists of the Family Centered Experience and Longitudinal Case Studies, is to help to foster the development of physicians who are skilled in, and committed to, the humanistic practice of medicine. Essential elements of this practice include working collaboratively with patients, their families and health care providers to alleviate suffering and optimize health; possessing a critical awareness of one’s own perspectives, ethics, and biases, as well as those of others and society; and recognizing areas of societal need and injustice, including health care disparities, and as a professional, acting to address those needs.

Objectives

Family Centered Experience And Longitudinal Case Studies

Mission Statement
The overall goal of the Family Centered Experience and Longitudinal Case Studies courses is to help to foster the development of physicians who are skilled in, and committed to, the humanistic practice of medicine. Essential elements of this practice include working collaboratively with patients, their families and health care providers to alleviate suffering and optimize health; possessing a critical awareness of one’s own perspectives, ethics, and biases, as well as those of others and society; and recognizing areas of societal need and injustice, including health care disparities, and as a professional, acting to address those needs.

Intended Learning Outcomes (Abbreviated)

I. Knowledge Objectives
By the end of the course, students are expected to demonstrate:

  1. An understanding of how basic science information relates to patients and their illnesses, linking the theory with the practice of medicine.
  2. A basic understanding of the impact of illness on the patient’s sense of identity and meaning systems, as well as his/her daily activities, relationships with others and plans for the future.
    • A basic understanding that illness has effects on both the patient and the family, not only clinically, but also on psychological, emotional, financial, and social levels as well.
  3. An appreciation that health beliefs and behaviors vary widely among individuals, and are shaped by one’s history, i.e., personal, family, cultural, and socioeconomic experiences.
  4. A basic understanding of the impact that a patient’s age and stage in life may have on his/her experience of an illness or medical condition.
  5. An appreciation of how a patient’s home and work environments (social interactions, lifestyle, socioeconomic status, type of work, support systems, etc.) affect their health and ability to care for him or herself.
  6. A basic understanding of the influence that families and support systems may have on a patient’s health behaviors and response to illness.
  7. A basic understanding of the various resources that patients use when seeking health care, and factors that represent obstacles in getting access to health care.
  8. A basic understanding of various social resources that are available to patients/families on personal (e.g., support systems), community (e.g., churches, mutual aid associations, etc.) and governmental levels (e.g., unemployment services, assistance for elderly family members, food stamps), as well as the factors that determine patient options and choices.
  9. A basic understanding of the importance of continuity of care and the ongoing physician-patient interactions in managing chronic health problems for which no cure is available.
  10. An ability to identify factors that assist in, or prevent, the development of an effective relationship between patients and their families, and their physician(s). Elements in this relationship include:
    • Trust
    • Rapport
    • Non-judgmental approaches
    • Respect for self-determination
    • Non-verbal communication
    • Confidentiality
    • Ability to discuss difficult or sensitive issues (e.g., sex, substance abuse)
  11. A basic understanding of the ways in which the culture of patients affects their perceptions of, and responses to, health, illness, and health care.
  12. A basic understanding of conventional Western and complementary/alternative therapies for health maintenance and for treatment of diseases and medical conditions, and how a patient’s beliefs influence his/her therapeutic choices and decisions.
  13. An appreciation and understanding of how health care decisions are made; i.e., What was the process? Was a particular decision arrived at collaboratively between the patient and his/her physician? Were family members involved?
  14. Students should have a basic understanding of how patients access care and navigate around a variety of services in the context of receiving health care (e.g., scheduling appointments, transportation, justifying or making up for missed work or school for clinic appointments, specific requirements of clinic visits, e.g., fasting/diet issues).

II. Skills objectives
By the end of the course, students would be expected to demonstrate:

Skills 1
Communication skills that are fundamental to an effective doctor/patient relationship, including:

  • Establishing rapport
  • Empathic, non-judgmental communication
  • Effective listening skills
  • Effective non-verbal communication skills
  • Responding effectively to a patient’s emotion and psychosocial concerns

1. Professional Attitudes, Behaviors, and Characteristics
An understanding and respect for the diversity of patient’s and family’s personal and health belief systems and perspectives, family structures, values, and how they affect health care decisions.

An ability to suspend personal judgments and biases and communicate effectively and empathically in situations in which there may be conflicts between the health and personal belief systems of the patient and family and their own.

2. Professional Attitudes, Behaviors, and Characteristics
Accountability and commitment to this experience, and to the patients and families, in the context of concurrent curriculum responsibilities.

3. Professional Attitudes, Behaviors, and Characteristics
Expression of compassion toward the patient and family, i.e., an understanding of the patient with the illness rather than the disease in the patient.

4. Professional Attitudes, Behaviors, and Characteristics
(Confidentiality)

Appropriate confidentiality related to patient and family information.

Skills 2
The basic ability to conduct a home visit with a patient, i.e., professional conduct and facilitation of patient and family responses.