The social history also is crucial. If you are aware of your patient’s living arrangements or his/her access to transportation, you are much more likely to devise realistic, appropriate interventions. Ask about where he or she lives; neighborhood safety; eating habits; tobacco, drug, and alcohol use; typical daily activities; and work, education, and financial situations. It also helps to find out who lives with or near the patient.
Understanding a person’s life and daily routine can help you to understand how your patient’s lifestyle might affect his or her health care. To this end, determine if the patient is an informal caregiver for others. Many older people care for spouses, elderly parents, or grandchildren. A patient’s willingness to report symptoms sometimes depends on whether the patient thinks he or she can “afford to get sick,” in view of family responsibilities.
obtaining the medical history 17
House calls by a health care professional are an excellent way to fi nd out about a patient’s home life. If that’s not possible, try to learn some details about the patient’s home life: “Do you use oil or gas heat? Have steep stairs to navigate? Own a pet? Can you get to the grocery store or pharmacy on your own? Are you friendly with anyone in the neighborhood?” Learning about your patient’s home life will help you understand aspects of his or her illness and may improve adherence to treatment.