Gathering social network information

The patient's social context includes past and current affiliations with friends, coworkers, and cultural and religious groups. Social networks form more than a 'backdrop' for a patient's life activities; rather, people, families, and social networks are constantly interacting with and changing one another, and thus should be considered as part of the patient's context.

It is helpful for the clinician to find out which social networks are most important to the patient.

• Start with an open-ended inquiry to elicit the patient's concerns about the social networks he or she is describing. ('Tell me more about yourself—your background, work, and activities that are important to you.')

• Wait until the patient mentions a family member, colleague, or friend spontaneously, then pursue a line of questioning about that particular relationship. ('You just mentioned your boss. How are things going at work?' 'And, what about other people or activities that are important in your life?')

• Tie in questions about social context with observations or questions about the patient's concerns. ('You have mentioned a particularly harrowing encounter. In what ways do you think this is contributing to your anxiety in general?')

• Avoid premature interpretations. Although it is often tempting to interpret patients' reports of relationships and life events, beware of doing so prematurely.

The family physician often plays an important role as family counsellor, and is often central to patients' social and health care support systems. When acting as counsellor, the family physician's knowledge and status helps the patient and family make sense of medical information, including that from mental health professionals. Mental health professionals can forge alliances with family physicians working in the same community, incorporating their opinions and knowledge of families into treatment (see Tab!").

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Table 6 Guidelines for mental health professionals working with primary care physicians

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