dr. nowak: sometimes the most important prescription has nothing to do with medication

a good social prescription can be transformative, shifting the conversation between a patient and a doctor from asking 'what’s the matter with you?' to 'what matters to you?'

by dr. dominik nowak

published feb 17, 2022

4 minute read

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4 minute read

join the conversation

dr. nowak: sometimes the most important prescription is not medication

in fact, sometimes the most important prescription we can make as doctors is a social prescription that can lead to sustainable improvements in health. getty

at the doctor’s office: sometimes the most important prescription is not medication. every day in the clinic, i see the importance of social factors on the health of the people in my family practice. george, a long-time patient of mine, had lost his partner to cancer earlier in the year.

comprehensive treatment for his mental health meant working together to review medical next steps and finding a talk therapist. just as important, however, was a prescription for a social need he identified — loneliness since his partner’s passing. we talked about a prescription for ‘social connection,’ and what that might mean for him. george chose to take a step to re-finding his sense of purpose and connectedness by volunteering with a local hospital.

we know that loneliness increases the risk of heart disease and stroke, often compared to smoking 15 cigarettes per day. it also has a strong bearing on mental health. although medications and talk therapy form a cornerstone of mental health treatment, so does bringing back feelings of connectedness.

social support and connections are just one part of what are called the social determinants of health, which are the social and economic factors that influence health. others include income, housing, food security, transportation, nearby green space, impacts of racism, childhood experiences, and more.

importantly, these elements layer on top of each other to form 80 per cent of health and determine entire trajectories of illness. when i meet someone as their family doctor, many of these factors are just as important to me as their medical history.

in clinical practice, social prescriptions are medical recommendations addressing social factors. but social prescriptions are often misunderstood. here are examples of social prescriptions in my practice:

prescribing connection and purpose for mental health

on a big-picture level, modest investments in spending on social interventions based in the community have been associated with decreased mortality. in other words, people live longer when you address social factors.

the alliance for healthier communities’ rx: community social prescribing pilot project is a vivid example. in it, people receiving help for social needs noted decreased feelings of loneliness, improved mental health, and an elevated sense of community belonging.

these interventions are important: they lead to better health and help maintain health-care resources such as hospitals.

recognizing these positive influences on employees, organizations are also embracing social interventions. at telus, for example, giving back to the community is central to the company’s stated value of “we give where we live“. since 2000, team members and retirees have contributed more than 1.8 million days of service.

giving back isn’t just good of us, it’s good for us. for those of us who have the opportunity, volunteering fosters a sense of belonging, builds empathy and trust, improves self-esteem, and studies even show it improves mood, stress, and chronic illnesses like high blood pressure. giving back can not only make us feel more connected with our community, but also healthier and happier.

prescribing caregiving support for diabetes

diabetes is linked to almost half of heart attacks, a third of strokes, half of all kidney failure needing dialysis, and is a leading cause of blindness. it can reduce lifespan by a decade. yet beyond the variety of highly effective medications available for diabetes, many of the other ways to prevent and treat the condition are heavily reliant on social factors.

for sam, another person in my practice, their commitments to work and family caregiving made it very difficult to exercise regularly or be proactive about nutrition despite their diabetes. in their case, caregiver support for their family (found through accessing resources, such as by calling 211 or the ontario caregiver organization’s 24/7 helpline), opened up time and freedom to focus on their own health.

prescribing activity for falls

one in three older adults experience a fall each year. in older adults, four out of five hospitalizations due to injury are because of a fall, including broken bones but also the after-effects on mobility, quality of life, and risk of further falls. when someone in my practice has a fall or is close to having one, it is an event we take seriously.

jamie visited my clinic after a fall led to a hospital admission. jamie’s family lived two hours away, and this recent fall meant worrying about getting out of the home alone. through 211, a local centre for older adults paired her with a friendly visiting program run by students. jamie was able to get outdoors regularly and safely, keep her bones and muscles strong, all while making new friends and continuing to live in her own home.

a good social prescription can be transformative. it shifts the healthcare dynamic from asking “what’s the matter with you?” to “what matters to you?” of course, merely dictating a solution, however well intentioned, can miss the mark — which is why social prescriptions must be co-designed. in doing so, they promote the strengths of that individual and emphasize their connection to their loved ones and community.

in fact, sometimes the most important prescription we can make as doctors is not for medication, but for a social prescription that can lead to sustainable improvements in health.

any of the stories shared in this column are rooted in clinical practice but fictitious composites, meant to illustrate themes in modern healthcare.

dr. dominik nowak is a family doctor and faculty member in the dalla lana school of public health and the department of family and community medicine at the university of toronto. outside of his clinical work, dr. nowak is a recognized leader in primary care and health systems strategy. as chair of the telus medical advisory council, he is a trusted advisor to telus and other canadian organizations in supporting health policy that is based in science and compassion.

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