SF General treats patients by considering ‘whole life story’

As mental health increasingly becomes a statewide priority, Zuckerberg San Francisco General Hospital is embracing a more inclusive treatment method for those struggling with addiction and their mental and physical health.

The nearly 7-year-old social medicine program — which its website claims has served more than 6,000 patients since it was founded by Dr. Hemal Kanzaria in 2017 — looks at how every aspect of a patient’s life can play a role in their health outcomes. Factors such as housing, family and food insecurity can lead to physical injuries, but they can also have a profound effect on how people manage their substance-use issues and mental health.

“Social medicine is really looking at people’s social needs and how they interact with their health care,” said Dr. Riham Alwan, a pediatric emergency-care physician at the hospital.

Alwan said she wanted to get a master’s degree in social work while she pursued her medical degree, but her school told her this was impossible. She said her first practical experience with social medicine occurred during a fellowship at the Cincinnati Children’s Hospital Medical Center, where she researched refugees and their interactions with the U.S. health-care system.

“How is your health affected by this severe trauma of being victimized and having to move somewhere you don’t know anybody and start your life all brand new with your preexisting health conditions?” Alwan said.

She connected with Kanzaria — a professor of emergency medicine at UCSF and the chief of performance excellence at SF General Hospital — in 2019 while interviewing for attending-physician jobs. She said she found what she was looking for in the program, which was 2 years old at the time.

“My intersectionalities found a place,” she said.

The services provided include such things as permanent supportive housing, food vouchers, and supplies such as cell phones and clothing. Alwan said it originated as a time- and cost-saving method for patients and the hospital, which “would allow them to better take care of their health at home or set them up for a better stay at the hospital.”

“Being in health care, you can’t help but recognize that our patients have these underlying social, environmental and economic factors that influence their health,” Kanzaria said. “It’s really acknowledging that our patients come in with their whole life story.”

Ideally, he said, health-care workers would be able to approach patients’ medical and nonmedical needs with the same level of care and attention in order to properly support them.

“They have both traditional physical health ailments as well as these underlying social factors,” he said. “We see that manifest when we take care of patients.”

The program, which is now a fully-funded program with the San Francisco Department of Public Health , has a medical team, a substance-use counselor, an intensive case manager and a patient-care coordinator. Team members provide daily consultations to patients who come into the emergency department.

“We go physically around the emergency room and talk to different providers, remind them about our services, and see if there’s anybody that they would like us to help with,” Alwan said.

Alwan and Kanzaria said patients’ most pressing issue is often housing, with about one in three patients experiencing homelessness. The other major issues include addiction, substance abuse and food insecurity .

While the team can refer patients to shelter beds, there aren’t always enough beds to meet demand. Permanent supportive housing is also sometimes difficult to secure for patients, the doctors said.

“It really is tragic how high the need is and how closely related it is to patients’ outcomes,” Alwan said. “Patients who are marginally housed or just at the edge — and then one illness pushes them to not being able to manage their checks, putting their money towards something else, and then they’ve lost their room.”

When the team is unable to connect a patient with housing, they connect them with other community resources outside of the hospital system, such as the addiction-treatment nonprofit HealthRight 360.

If a bed or housing is unavailable at one of those organizations, then the social-medicine team tries to put together a plan for the patient for the following day, or later that week.

The program measures success by tracking prevented emergency-room visits, tallying how many patients would have otherwise been readmitted at San Francisco General or visited other facilities in The City. It has prevented 800 such visits, according to its website.

“We also interview patients and we ask them if their needs were met, whether or not they felt like they had what they needed to take care of their health, whether or not their social needs were addressed in the [emergency department],” Alwan said.

The program isn’t the only one of its kind in the Bay Area, with social medicine initiatives at Highland Hospital in Oakland and Stanford University. The San Francisco General team said it is considering ways to expand in an effort to help The City address its systemic issues.

“We’re not going to solve homelessness for our whole community, but I think we can, with partners, be very effective,” Kanzaria said.