I continue to be fascinated by Social Networks and addicted to systems thinking since returning from the National Institutes of Health Institute on Systems Science and Health in 2012. Social connection, or even unfortunate social isolation, becomes most evident during illness and should not be ignored. In light of the recent Patient Care and Affordability Act, I would like shed attention to why medical care must pay attention to networks of social support as a part of the health care equation to assure the best care possible. Medicine must understand how the support looks and works as a web of complicated, changing connections. For instance, if a person has a medical home for the treatment with a chronic illness, there will be clinicians and health professionals to facilitate care and would be in the patient’s social support network. What a clinician is not privy to the invisible elephants in the room, in the form of supporters that influence the quality of the patient’s medical outcomes and quality of life as the patient “lives” his or her life.
How might this idea apply to medical care? With the noted exception of ventures into telemedicine, medicine still requires a physical meeting between the patient and the clinician. But what of the other invisible elephants in the room, such as the niece who makes sure that Granny gets to the pharmacy to buy new lancets, the emergency room attendant who sought to piece together the patient’s health narrative under duress, or even the televangelist that promised of a bodily healing of that ulcer with each dedicated tithe to the ministry? The discussion needs to happen in order to carefully broker desired medical outcomes in light of these invisible influences.
Each support person has varying amounts of influence in the life of the patient. Why must we talk about clinicians interacting with other members of a patient’s social network? Take for instance chronic disease management as an example. In times of chronic illness management, the bottom line is: are the elephants the friends or hindrances of the clinician and perhaps, more importantly, of the patient? Since this support network is undeniable and at times inaccessible to clinicians, how do clinicians play nice? To this end, navigating illness requires the expertise from a variety of clinicians and health professionals. However it cannot be underestimated that influences of concerned others without a health credential that make up the patient’s network. Intervening at the point of patients’ accessible and unreachable elephants as leverage may yield greater understanding of health outcomes that have resulted in higher burdens of disease, increased health care utilization as well as financial and emotional burdens on families and society. Welcome to the medical Big Top and let the ingratiation of the elephants commence.