Intended for healthcare professionals

Rapid response to:


If social determinants of health are so important, shouldn’t we ask patients about them?

BMJ 2020; 371 doi: (Published 24 November 2020) Cite this as: BMJ 2020;371:m4150

Rapid Response:

What happens to knowledge of social determinants in primary care?

Dear Editor

I have been a GP for 20 years, working in a deprived practice routinely asking about social determinants of health and learning over time about the complex networks of family and social relationships, experiences of violence, abuse, and other tragedies, as well as protective and buffering factors in peoples lives that offer more or less resilience to the trauma they have endured.

Where the authors claim,

Social determinants are not routinely asked about, documented, or coded in clinical settings. The health service is, in effect, blind to those social determinants of health and healthcare.

The issue isn't that we don't ask or document, it's that clinical systems (Electronic Medical Records) are designed to code and collect clinical data for audit and finance and are not designed for the purpose of collecting narratives, contextual information or details about social determinants.

In a way the authors acknowledge this,

"General practitioners spend large amounts of consultation time on non-medical issues relating to welfare benefits, housing, or unemployment."

It's impossible to spend large amounts of consultation time on these issues without asking about social determinants of health and healthcare, and we use this information to advocate on behalf of our patients for benefits appeals and social prescribing referrals, housing letters and so on.

One recommendation I would recommend would be some qualitative ethnographic/action research to see what is happening already in primary care and how that can inform interventions to support patients and professionals working in the Deep End.

Competing interests: No competing interests

24 November 2020
Jonathon Tomlinson
The Lawson Practice, Hoxton N1 5HZ