Article originally appeared in the March 2017 issue of the Journal of the Arkansas Medical Society.
Does it take more that health care to cure Americans’ ailments? One area often overlooked in diagnostic and treatment plans are the many social determinants that can affect a patient’s health.
For example, poverty can lead to malnutrition, which can lead to immunocompromise and concomitant diseases—especially among the elderly. Poor housing situations can lead to diseases related to pest infestation, allergies related to an allergen-rich environment, lack of security leading to mental disease like depression, etc. Abusive relationships can lead to depression, sexual dysfunction/disease, weight loss, chronic pain, and many other symptoms. Unemployment can lead to depression and financial crisis that limit a patient’s ability to comply with treatment recommendations. I think one reason doctors tend to overlook or avoid these issues is because we don’t know what to do to address them.
Sometimes the consult a patient needs to regain physical health is not from another doctor, but instead from someone who knows the law. Some researchers estimate that one of every six people needs legal care to become healthy, so having patients consult an attorney (family lawyers, transactional lawyers, bankruptcy lawyers, disability lawyers, etc.) —instead of another medical specialist—may be exactly what is needed to cure his or her ailment.
Most lawyers don’t sue doctors, so you are not generally risking a lawsuit against yourself by referring a patient to an appropriate lawyer to help fix the social issues contributing to health problems. A 55-year-old, unemployed, disabled, former factory worker may be able to afford necessary medications and therapy—instead of becoming a noncompliant patient—if an attorney helps him qualify for social security disability benefits. A temporary guardian ad litem provided by an attorney to look out for the child’s best interests might make a tremendous difference in that child’s mental health and any physical manifestations (somatization) related to a bad domestic situation at home. A bankruptcy lawyer may help cure a patient’s ulcers or anxiety symptoms by removing the constant stimulus of anxiety-inducing creditor calls.
To help address these and other social determinants of health, some innovative leaders in Arkansas have already set up medical legal partnerships (MLPs) between healthcare providers and attorneys in several communities. LegalAid of Arkansas (1-800-9-LAW-AID) helps provide some basic services at minimal to no charge for qualifying persons. Arkansas already has several centers for MLPs that incorporate lawyers into the healthcare teams. These include MLPs at the Mid-Delta Health Systems (Clarendon), Arkansas Children’s Hospital, Mid-South Health Systems (West Memphis), Veterans Healthcare System of the Ozarks (Fayetteville), ARCare (27 communities), and CHI St. Vincent (Little Rock). If you see the need in your community, you might be able to get a similar MLP set up near you.
Attorneys can help patients with many things—like getting SNAP (Supplemental Nutrition Assistance Program) benefits, securing housing vouchers (HUD), protecting housing rights, obtaining SSI (disability), qualifying for Medicare or Medicaid, inducing schools to provide educational programs for disabled or special needs children, helping address domestic violence, helping provide stable guardianship for minors, addressing discrimination, filing for bankruptcy, etc.—any of which may be exactly the “treatment” that your patient needs.
So, the next time you face a treatment dilemma for a health problem that seems to be related to a difficult social determinant of health, consider contacting a local attorney with expertise in the appropriate area or consider checking with LegalAid of Arkansas for advice or assistance. The law sometimes provides for “just what the doctor ordered” to cure otherwise difficult health problems … a treatment option that we may sometimes tend to overlook.
Dr. Griffin is a retired orthopaedic surgeon and an adjunct professor at the University of Arkansas School of Law.
