While often overlooked, a patient’s social history can help narrow the differential diagnosis as well as help guide their final disposition. A mnemonic to help with the essential parts of the social history is ETOH SHOTS:
- Level of education of the patient; are they able to understand discharge instructions.
- Does the patient have a drug plan to help cover medication costs, can they afford the medications you are prescribing.
- Does the patient have any children or social support that can help care for them upon discharge.
- Location and safety of patient’s home, and whom they live with.
- The patient’s sexual partners, sexual preferences, history of an STI (including past or current partner exposure).
- Smoking, alcohol consumption, and drug use.
- Toxic exposures or injuries that may prevent the patient from being able to work.
- Infectious disease related illnesses specific to the areas a patient has travelled to.
- May lead to what the causative agent may be.
This post was copyedited by Michael Bravo (@bravbro).
The social history can provide key clues to the diagnosis of an illness – for example a patient with increased shortness of breath who’s final diagnosis is interstitial lung disease, only determined after soliciting the occupation of the patient who works at a factory. Discussing the social history from a patient can also give the chance to connect with the patient as a person, and allow us to provide better care.
The Center for Disease Control’s (CDC) latest report on health disparities highlights that income and education impact health. Take the hypertensive patient that repetitively presents to the ER, and turns out it is because he lost his job and is unable to afford his medications. This history is just as important to elicit as their past medical history. How do our patients afford to pay for their housing, medications, and do they have a safe place to be discharged to. These important factors play a key role in taking the best care of our patients we can and ensuring a safe and appropriate disposition.