This introduction is to showcase how the Social and Population Perspectives (SocPop) theme will be applied in clinical scenarios to help you as students understand the current and future benefits in learning the content within this theme.

3 patient profiles have been put together for you to have examples of how some of the general principles behind SocPop are applied in real clinical scenarios.

What are we trying to show with the cases?

• Attempting to showcase the use of SocPop principles to real patient situations
• How the use of it can help achieve GMC aims in tomorrow’s doctors
  • Apply social science principles, methods and knowledge to medical practice (paragraph 10)
  • Apply to medical practice the principles, methods and knowledge of population health and the improvement of health and healthcare (paragraph 11)
  • Apply scientific method and approaches to medical research (paragraph 12)
• How it can assist in our (medical students) understanding of patient situations that may differ vastly from our own life experiences

Principles of SocPop to showcase

• Model examples to help with understanding complex behavioural patterns
• Use of language and relationships with patients.
• How to work with patients as a provider for their wider wellbeing not just biological need

Profile 1 - Doctor/patient relationships

Ruby Smith
Age: 17

Ruby has come into the surgery today to chat about some morning sickness she has been having. She is pregnant. The doctor she is talking to has only seen Ruby a few times but remembers that Miss Smith has often made up her mind about what she wants from a consultation before coming into the surgery.

The doctor, assuming a link between the nausea and the pregnancy, informs Ruby about how common morning sickness is, but advises her to seek help if it doesn't stop after a certain period of time. He tells her how best to handle the sickness and some of what she can expect going forwards with her pregnancy.

We cover a few types of Doctor-patient relationships in our first year at medical school. This is an example of a paternalistic relationship, as the doctor takes the lead and the patient talks little. This is not an ideal relationship, as in this case it is not certain that the sickness is related to the pregnancy (though likely), there may be other symptoms or significant history that Miss Smith feels unable to express. This could leave her feeling undervalued, or worse, mis-diagnosed. The GMC currently advocate a shared relationship where both doctor and patient views are taken into account, but this will be covered more in your lectures.

Profile 2 - Attitudes towards health

Barry Patrick Harris
Age: 55

Mr Harris has presented to his GP with worsening urinary retention (finding it difficult to pass urine, bladder feeling full). He has suffered from this problem for 6 months but did not want to bother the doctor with the problem until now, as he is unable to pass urine at all.

Whilst we don’t want to stereotype patients, there are definite behaviours that trend across groups of people. For men, we expect less use of their GP compared with women (generally). Mr Harris is an example of a patient with worsening Benign Prostatic Hyperplasia; a common complaint among aging men. It is also common for them to wait until they can’t urinate at all before seeing the doctor. This and many other socioeconomic trends will be explained to you throughout your year.

There are also differing societal attitudes towards health, in how you damage it, how you treat it, when you seek help; all contributing towards a picture of health that makes each patient unique. It is important to understand where these diversions from normal occur (what even is normal?) as your patients will be better understood, and should have better treatment concordance as a result.

Profile 3 - Statistics and screening

Mrs Sandra Jones
Age: 62

Mrs Jones has come into the clinic for a smear test. This is a routine test offered to all women over the age of 25. The results from the test come back positive. The doctor has to explain the results to the patient and what this could mean for her future.

In SocPop, one of the many areas we cover is screening. Not all screening programmes are necessary or effective. We will be shown how to identify good and bad screening programmes, looking at statistics relating to the performance of the screening test to detect the disease and thinking about social and political drivers for why they happen.

Here, the patient may have received a false positive result; where the screening test says the disease is present, but in reality the patient does not have it. Better screening tests minimise these false positives as they cause unnecessary worry, invasive investigations and sometimes unnecessary treatment. Treating this patient would be an example of a screening bias, as treatment will lead to positive outcomes for their perceived health; their ‘disease’ will not worsen, the ‘treatment’ will have worked, and so they will report that screening was a positive experience. In reality, they did not need the treatment at all.

This and other biases will be explained in detail throughout phase one.

Conclusion

This should give you a flavour of the kind of areas covered in the SocPop theme throughout phase one. The theme starts with ‘what is health?’ and expands from there, hopefully allowing medical students to appreciate the vast diversity of patient experiences.

Any questions, please feel free to contact Damien Coleburt (d.coleburt@warwick.ac.uk)