Çocuk Hekimi Gözüyle Sosyal Öykü ve Sosyal Öyküye Engeller: Nitel Bir Araştırma

Abstract

As part of the patient anamnesis, social history provides an opportunity to pediatricians for fulfilling their advocacy duties. Despite its significant capacity for such an assistance, social history remains underappreciated with its limited utilization in clinical practice. The purpose of this study was to evaluate the social history in the light of pediatricians’ experiences, and to develop a deeper insight into the reasons limiting the use of social history. With this regard, a qualitative research method with an interpretivist approach was used. In-depth interviews were done with 12 physicians, 11 of whom were pediatricians (residents and specialists). Additionally a focus group study was conducted with 6 residents. According to the content analysis, focuses of the social history are (1) relationships, (2) socioeconomic status and (3) everyday life of the child. It has been found that, direct questions, regarding the socioeconomic status are not addressed adequately. Instead, interviewed pediatricians prefer to observe and estimate the socioeconomic status of the family. Although the social history concepts of interviewees are quite wide, they have stated limited implementation in daily clinical routine. Biomedical approach seems to be the main reason for that limited use of social history. Biological view of health leads pediatricians to solely focus on “diagnose and treat”, which hinders them from preventive and advocacy services. Other causes seem to be time consraints, lack of education and inadequate interdisciplinary work as well as problems with the referrals. We believe, there is an urgent need to question the biomedical approach in order to ensure enough time for patient visits, to teach the social history in the context of social determinants of health with interdisciplinary work and to develop effective referral strategies.