The IMPACT Q framework: teaching medical students how to gather a psychosocial history

INTRODUCTION

Many patient visits in primary care are driven by psychosocial concerns¹ and medical illness is invariably linked to these. Yet when we teach undergraduate medical students to explore such psychosocial issues in the standard social history, in practice this often comprises a limited number of questions relating to smoking, alcohol, and occupation. Junior doctors, trainees, and students infrequently ask about the impact of an illness or problem on issues such as the patient’s ability to provide for themselves or on the psychological impact. These questions are more meaningful to patients than being asked about their use of recreational drugs or cigarettes in the traditional social history, where such psychosocial issues are often explored and contained near the end of a patient’s history. Failing to ask these important questions relating to impact of a problem on a patient’s life, in a natural and fluid way throughout the history, can lead to a disconnect between the clinician and patient agenda. Furthermore, this disconnect can make it difficult to move towards approaches such as shared decision making, management plans, and self-care, which are all essential outcomes in the current NHS.

It is hoped that, by encouraging a more natural and reflexive questioning style to emotive psychosocial issues, students will be able to really listen, understand, and react to these feelings in an appropriate way in real time. The current history-gathering template is therefore at risk of contributing to the so-called ‘empathy erosion’ where there is a decrease in compassion and empathy in clinical medical students, as they start viewing patients as cases needing to be medically managed, with psychosocial issues often shackled to the social history tagged on to the end of the encounter. This article aims to address the imbalance of biomedical versus psychosocial enquiry in current clinical history …