Article Figures & Data
Tables
- Table 1. Examples of love and breakup letters (not real letters that participants in this study wrote). SDoH = social determinants of health
Love letter I am grateful to youYou always encourage me to pay attention to SDoHThanks to you, I can improve the quality of my practiceThanks to you, I can treat difficult patient encounters without having negative feelingsYou always enhance my identity as a primary care physicianTruly, there are many things that I cannot do on my ownHowever, you help me keep motivated to make our society betterThanks a lot Breakup letter Enough is enoughWhat you are saying is just fine-sounding talkIt is hard work to address patients' social difficulties, for which I receive little gratitudeWhatever you say, I cannot change societyYou are just exploiting my motivationYou impose enormous challenges on me in my busy practiceMy patience has reached its limitI don't even want to look at you anymore Characteristic Median age, years (range) 40 (28–55) Self-reported gender (% female) 38.1% Duration of clinical experience, years 3–6 (resident) 7 7–10 4 11–15 2 16–20 5 ≥21 3 Main clinical setting, n Residenta 7 Clinic 4 Community hospital 6 Academic hospital 4 aIn Japan, family medicine residents usually experience various clinical settings, including clinic, small-sized hospital, large hospital, and academic hospital.
Theme 1. Primary care physicians take pride in being expected to address SDoH Sub-theme Explanation Integrability with primary care Addressing SDoH is essential to primary care.Underlying factors are: Affinity with biopsychosocial model
Best position (accessibility, comprehensiveness)
Excellence in primary care Excellent primary care includes addressing SDoH. Experienced physicians: reaffirmation of the value in their practice
Novice physicians: identity formation
Theme 2. Primary care physicians rely on the recommendations as a partner even in difficult situations Authoritative supporter Recommendations validate: What primary care physicians have done
Frustration and hesitation about patients’ social issues
Encouraging friend Busy practice leads physicians to ignorance of SDoH In supportive surroundings, they favour SDoH recommendation
3. Primary care physicians consider the recommendations to be bothersome, with unreasonable challenges and demands, especially when supportive surroundings are lacking Excessive burden Recommendations impose on enormous challenges.Negative effects: Physicians disregard the importance of SDoH
Physicians feel guilty
Physicians underestimate their skills
Antipathy driven by unsupportive surroundings Busy practice leads physicians to ignorance of SDoH In unsupportive surroundings, they disfavour SDoH recommendation
4. Primary care physicians reconstruct the recommendations on the basis of their experience Not following the recommendations literally Recommendations are transformed and contextualised Learning and practice based on real-world experience Recommendations trigger multi-layered learning and practice SDoH = social determinants of health.