Salus Health Care Forum July 2, 2025

 Bill B

The connections between the individual and the community are very interesting and important. Several of you have talked about the intermediary, the neighborhood. And it’s interesting that rather than just go from the individual to entire community, we begin to talk about the neighborhood. It is important to consider whether that neighborhood is real, like people living right around you, or the neighborhood is digital. We used to think of digital as being something that throws people into alienation, but are there digital neighborhoods that are mediators in some ways that help?

Jeremy

I like that you bring that up because I think we talked about family too. So family and neighborhood might be kind of the term. People have families of choice, right? Later in life, they may discard their family of origin for various reasons or expand their family of origin into their sort of family, what I call family of choice.  There’s that Dunbar number. Of 150 people, that’s about the number with whom we have somewhat meaningful neighborly-like relationships. And that maybe we’re under-exploring the many ways people are creating that now. Some of it is very unproductive. For example, radicalizing themselves and becoming terrorists would not necessarily be a good use of neighborly connection. But there are virtuous neighborhoods that may be popping up in the virtual realm as well. So, there are some hopeful signs there. One other term I just wanted to bring up since we hadn’t said it explicitly is post-traumatic growth. This is another area of emerging science where, and you don’t want to say we should traumatize everybody because then they can grow, but maybe a third of the population that experiences the same event will have a transformative life experience that changes them for the better in their own minds and lives. A third will stay roughly the same and a third can get the PTSD types of responses. And I think knowing those facts, it really makes you curious. Is there a way to nudge people in the right direction. Going from PTSD to neutral would be great, going from neutral to growth would be great. And I’m curious what people think about that.

Jack

We used SCOPE notes back in the day when I was teaching in residency. We added the C to the SOPE, the standard subjective objective assessment plan. The C was context, and this was in the 90s when everyone in the family was in one folder, and then each individual had a folder. When we went to EMRs, we lost the ability to do that. And unfortunately, I’ve not seen a good EMR that really pulls both family and context into the note.

Bill G

Well, in fairness, Jack, EPIC does have a very nice social and family history module that you can put in any note, or you can attach it to the overall context of that particular chart. But people don’t tend to use it very often. When we were participating in the Comprehensive Primary Care Plus initiative, that was a required element that you included in your charts. The problem is, you were supposed to have some sort of intervention plan associated with that. That was part of the requirement of participation. And that proved to be extremely difficult.