Primary care physicians’ perceptions of social determinants of health recommendations: a qualitative study

Junki Mizumoto; Toshichika Mitsuyama; Masato Eto; Masashi Izumiya; Shoko Horita

doi:10.3399/BJGPO.2022.0129

Article Figures & Data

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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

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Table 2. Participants’ demographics

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
Resident^a	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.

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Table 3. Summary of the themes and sub-themes

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 Background: addressing SDoH would be disregarded by other professionals
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