Table 2 Examples of reports that are evaluated as descriptive, analytical, reflective, and unable to evaluate

Descriptive

The diabetic patient I was in charge had less knowledge about diabetes (social disparity), liked thicker flavors, ate a lot of rice (food), had a poor work environment (work), and had worsening diabetes. As a healthcare professional, I felt it was necessary to provide appropriate information for each patient.

Due to large social disparities (low income, living on a pension), some people will not be able to go to the hospital and will be left alone when sick or injured, even if they need medical care. There are many elderly people in areas where transportation systems are not maintained, such as mountainous areas, but they cannot drive or afford to use a taxi. In areas with many elderly people, healthcare professionals need to visit patient homes and understand their living conditions and their relationships with family members.

Analytical

A patient with hypertension and renal insufficiency had such poor compliance that dialysis was indicated but was not introduced. The patient was discharged home with a life expectancy of several weeks to months. Due to a severely limited financial situation, there were no choices for nursing homes or nursing care. The personality of the patient was too emotionally unstable, so all family members denied support. These various social determinants not only affected the patients themselves, but are also shared by families that live together. They are intertwined in complex ways and contributes to health to illness.

There were many single male workers who were mainly engaged in manual labor. Drinking and smoking were common habits. Their lifestyles were irregular in a workplace with three work shifts. With this background in mind, we can see why an individual’s eating habits were disrupted and how we can improve their lives. Approach to these determinants can break the roots of a vicious cycle that might include being transported to a hospital repeatedly because of continuing the same lifestyle.

A woman in her forties who handled all housework alone was suspected of having a relapse of depression. Approaching only the current problems such as the lack of sleep and burden of housework does not lead to a solution. The essential approach is to consider what is the cause. Why was she in a situation where she had to do both housework and work? What was the economic situation? Was there a relationship with the community? Taking an even more upstream perspective is especially important when you cannot solve the problem or you cannot expect a solution.

Reflective

The social disparity was very impressive. Some people live in a dirty house, have loans, or can’t pay for electricity. Others live in a clean house and their families can clean their rooms every day and they get nutritious meals. The differences in clothing, eating, and living are greatly related to quality of life and, in turn, to patient health. The social disparities, stress, unemployment, food, childhood, etc. that we considered in this worksheet are all closely related and interrelated in the flow of individuals. Poor environments increase the risk of lifestyle-related and infectious diseases and poor nutritional balance can lead to reduced immune function and ill health.

One role that healthcare professionals should play in a community is to provide necessary health education. There are many places in the area where there is a system for cooperating with people around me, but sharing appropriate knowledge will help each other in the area and improve overall health.

Symptoms of an outpatient were related to stress (tired from family’s care, work fatigue, etc.), so we considered how to relieve stress. Tobacco use and gambling addiction were caused by poor work performance, unemployment, and poor family conditions. When unemployment, childhood events, family environment, etc. are related to health status, some people may not want to talk about their situation or want interference. Some patients may not have been able to speak out, but still I think it’s important to listen. The physician I met decided to become an occupational physician because many of the patients he met in the emergency department had health problems caused by their lifestyle, and he wanted to improve from there. In some cases, he was appreciated for conducting smoking cessation programs in the workplace because the results of medical examinations improved. As a healthcare professional, I thought that this can be done in a regional framework. I can understand the characteristics related to local health in advance and give lectures and advice.

Unable to evaluate

From the case of a paralyzed patient living in a dirty house, I learned that even with the same disease, the living environment could be abnormal beyond my imagination. In such a living environment, there are more diseases such as infectious diseases, so I felt it was meaningful for medical professionals to be aware of social determinants of health. I think the most important thing in the region is to improve medical facilities and build human relationships with local people.

There was a patient who was discharged early because of cigarettes and gambling. Cigarettes and gambling appeared to have a negative effect on health and should be stopped. However, for that patient, the place where he gambled was important for social relationships; without it, dementia may occur. I thought that focusing on SDH would enable us to provide medical care for patients that considered more than one aspect. The role of healthcare professionals in the community is not only to treat the disease, but also to consider and help ensure happiness for the patient.