Opinion: Checklists to screen for patients’ social needs aren’t helping
The well-intended "screen and refer" system is not only ineffective but also dehumanizing and even potentially harmful.
I once saw a patient who came to the emergency room with injuries that were clearly related to domestic violence. Instead of offering a compassionate ear and a blanket to cover her exposed body after an assault, her intake nurse rushed through a checklist intended to screen her for social needs. While facing the computer screen, the nurse asked the patient a series of sensitive questions, including one about whether she had experienced domestic violence. The patient, feeling put off by the nurse’s impersonal manner, denied having ever experienced any abuse.
In recent years, primary care providers like me have started to realize that we need to ask patients about all manner of topics, including domestic violence and whether they have access to a refrigerator if we prescribe a medicine that needs to stay cold. But these efforts have manifested themselves in the form of a rapid “screen-and-refer” approach, which involves asking patients to quickly complete checklists about their social needs and then automatically refer them to social service organizations.
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