As patients’ relationships may significantly impact their habits, adherence to treatment, and health outcomes, addressing suspected red flags in their personal lives without making assumptions or overstepping boundaries can feel like a balancing act.

 

Unhealthy relationship dynamics

Negative relationship traits can range from unsupportive comments to physical harm. Whatever the situation, relationships can affect a patient’s self-esteem and their likelihood of following through with medical recommendations.

Research published by The Journal of Rural Health found that social groups strongly influence health behaviors.

Sriram U, Morgan EH, Graham ML, et al. Support and sabotage: A qualitative study of social influences on health behaviors among rural adults. J Rural Health. 2018;34(1):88–97.

For example, smoking cessation is dramatically hindered when the individual is surrounded by others who smoke.

 

Additionally, barriers to healthy eating or physical activity often include family obligations and social pressure, including the food preferences and demands of others in the household.

How you can help

Posing questions to patients about what may be slowing their progress may help them consider factors that need to change. Pulling in key players (like a spouse) can help elicit better communication.

Although there’s not always time for these important conversations during a primary care visit, offering referrals to individual therapy, relationship counselling, and group classes can help improve your patient’s relationship dynamics and social support network.

While you probably wouldn’t go as far as advising a patient to leave their marriage, you could connect them with local organizations, such as a diabetes group or exercise class, that could help to make up for some of the support lacking at home and encourage them to prioritize their health.

 

 

Domestic violence situations

According to National Coalition Against Domestic Violence statistics, 33% of women and 25% of men have experienced some form of physical violence from an intimate partner.

Statistics. The National Coalition Against Domestic Violence.

For many, domestic violence takes a widespread toll and raises the risk of:

 

• Alcohol or drug use

• Chronic pain and chronic disease

• Gastrointestinal problems

• Neurological disorders

• Nutritional deficiencies

• Post-traumatic stress disorder

• Sexually transmitted diseases

• Stillbirth and miscarriage

As matters escalate, victims may also be at risk of losing their jobs or their lives. Depending on the circumstances, some of these individuals may not realize how unhealthy their relationship is, or in extreme cases, may knowingly or unknowingly become victims of human trafficking.

According to research published by the Annals of Health Law, 88% of human trafficking victims had experienced a medical encounter with a healthcare professional without being identified or assisted.

Lederer LJ, Wetzel CA. The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities. Annals Health L. 2014. 23(1):61.

That’s because human traffickers commonly go to great lengths to threaten and manipulate their victims to hide the abuse.

 

How you can help

People who are in abusive situations can be of any age, ethnicity, or economic background.

Implementing a clear policy that every patient must be seen individually for at least a portion of their visit can create separation from an abuser and provide an opportunity for them to speak up.

Providing patients with non-judgmental access to social services helps establish patient-provider trust. For those who come in frequently for sexually transmitted diseases or suspicious injuries, a coordinated effort to reach out and make the office a safe place to be vulnerable might make all the difference and even lead to a life-saving breakthrough.