Doctors are slammed with non-medical cases. Some say social prescribing could ease the burden
Suggestion of non-medical treatment shifts focus from, 'What's the matter with you?' to 'What matters to you?'
When a Toronto doctor sent out a tweet earlier this year of the prescription she'd just handed to a patient, she had no idea the impact it would have.
"Puppy of choice," it said, "with walks twice daily and lots of love." It was a real prescription, written on her prescription pad, handed to a patient experiencing feelings of loneliness.
Thousands of people liked it, shared it and left their own comments, many asking if they could be Dr. Iris Gorfinkel's patient, too. In the end, it reached more than 700,000 people.
"I think the reason that it struck such a raw chord is because people saw themselves in it," Gorfinkel said.
Just gave this Rx …for real. <a href="https://t.co/XdgXnivtQf">pic.twitter.com/XdgXnivtQf</a>
—@DrGorfinkelThe family doctor, who's been practising for more than 20 years, says she's been doing some form of what's now known as social prescribing since her earliest working days — suggesting non-medical treatments for patients who come to her with symptoms that suggest loneliness or isolation.
Anyone can benefit
By having physicians or other care providers refer people with non-medical symptoms to non-medical services available in the community, the hope is to ease some of the burden on the overstretched health-care system.
"Social prescribing can be used for anyone," said Kate Mulligan, an assistant professor at Toronto's Dalla Lana School of Public Health who spearheaded one of Canada's first formal hubs for social prescribing.
But she says it's particularly helpful for people from communities facing health inequities and need support in accessing anything that impacts the social determinants of health — non-medical factors that influence health outcomes — such as loneliness or isolation, housing, income or discrimination.
One of the groups most open and ready for social prescribing in Canada is seniors, says Mulligan. "Isolation has huge impacts on their well-being and those impacts can be pretty immediate and pretty significant and hard to bounce back from at times."
While there's great variation in how it's done, formal social prescribing typically involves a bridge person — often called a link worker, community connector or liaison manager.
"Just somebody who has the time and the training to really listen to you," said Mulligan, who is senior director for the Canadian Institute for Social Prescribing.
"They change the focus from, 'What's the matter with you?' to 'What matters to you?' "
It could be as simple as helping a person sign up for swimming lessons or a knitting circle. It might be driving them to a meeting of an anti-racism group — or even just finding them a pal to go fishing with once a week.
"They work with people to help them kind of rediscover their sense of purpose, their sense of connection in the community," said Mulligan. If necessary, the liaisons go along to make that first step a little bit easier and to get feedback on the results.
Making connections
Alan Widdows met his link worker a couple of years ago. The 73-year-old retired civil servant lives alone in East Vancouver. Months into the COVID-19 pandemic, he knew something was wrong.
"I had come to the point where my eating habits were atrocious. I had also become a chronic insomniac," he said. "And I was just falling into a really gloomy place where I did not feel well."
Because of lockdowns and fear of infection, he stopped seeing friends, stopped going to the Y and felt increasingly lonely and isolated.
His GP told him he might benefit from social prescribing. Widdows was connected to link manager Eda Ertan, and together they found activities in the community where he could feel safe but make connections.
First was a movement class — with lots of distancing and masking. He discovered just looking into someone's eyes and hearing their voice helped. He went on to join nature walks and more recently went with a small group to the symphony.
"Just being around other people began to, you know, lift some of the moodiness and, I suppose, emerging and worsening depression that I was feeling."
For Widdows, the collaborative nature of social prescribing was key.
"I lost some of my momentum and impetus, and I had very little motivation to do much about it, until Eda and I sat down and talked about what might help me," he said.
"I'm not out of the woods yet. But things are getting better."
Fewer doctor visits
Studies into the impacts of social prescribing from the U.K. show fewer visits to emergency and fewer visits to doctors, and Mulligan says U.S. research shows a reduction in burnout when providers socially prescribe.
Research has also shown that people around the world regularly consult doctors for problems that are primarily non-medical. Canada is no exception.
"You have, at the primary care level, patients coming in with issues which really aren't appropriately treated medically … where a non-medical prescription would be better," said Alayne Adams, an associate professor in the department of family medicine at McGill University.
Adams, who's been involved in global health research all over the world, helped develop a website in Montreal for health-care professionals to refer patients to nearby community services through social prescribing.
It could end up saving the health system money, Adams says, "because you don't have people coming back [to see a doctor] over and over again for non-medical needs when their needs are elsewhere."
Modern roots in the U.K.
The term "social prescribing" dates back about 100 years, but the modern form has taken rise internationally much more recently.
The current movement started in the U.K., with formal examples dating back to the 1990s, and has steadily gained traction over the past decade or so. It's now used in dozens of countries, including Canada.
In Ontario, social prescribing was piloted across 11 health community health centres in 2019. They created pathways to non-medical interventions and tracked the impact of the referrals. Among the findings was that health-care providers who used social prescribing reported a decrease in repeat visits.
In B.C., Dr. Grace Park spearheaded a social prescribing program in the Fraser Health Authority. It's one of five publicly funded health authorities in the province that serves almost two million people, about a quarter of which she estimates are seniors.
The program has been a success and Park, who is regional medical director for community health services, is now extending it into assisted living homes, acute care and even hospitals, as a way to identify seniors in the health system "that may have some barriers to getting home and convalescing and connecting back to their community."
But with just 19 community connectors in all of B.C., she says they're always looking at how to collaborate, increase the capacity of the connectors and reach as many people as possible.
Systemic challenges
Mulligan says while it's clear interest in social prescribing is growing in Canada, it's still mostly being done at the grassroots level — a project here, a program there.
"It's not happening system-wide," Mulligan said, but she hopes that as more successful projects crop up, governments and health systems will embrace it.
While there is positive anecdotal reporting from physicians, Mulligan says detailed research into impacts of social prescribing in Canada is still underway.
There are also more systemic challenges to overcome.
"It really does reply to all of those concerns that we have about social determinants of health. But it doesn't necessarily address the structural sort of factors which caused those disparities in the first place," said Adams, the McGill professor.
Social prescribing assumes services are available and easily accessible, which isn't always the case. It also relies on the individual being willing to take a lead role in their own health — and doctors like Gorfinkel, who recognize when it might help.
"When it does work out, it's really quite beautiful," she said, "because you can watch a person blossom."
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