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This month, we highlight a heartfelt social prescribing initiative by Dr. Leif Hass, a hospitalist in Oakland, CA, who prescribes simple, evidence-based activities like gratitude notes and reconnecting with loved ones to uplift vulnerable patients. Dr. Haas is part of Social Prescribing USA’s Health Professionals Champions group. He spoke recently to the group about his efforts. That video can be seen at this LINK.

Can you briefly describe your social prescribing program and the communities it serves?

I work as a Medical Hospitalist in Oakland, California. As is the case with all hospitalized populations, my patients are typically older, with chronic health conditions and socially disadvantaged. Hospitalizations often arise with the onset of a new serious health condition such as cancer, stroke or heart problems or from worsening of a chronic condition they have been unable to manage well at home.

In the former, my patients are often in shock and have a sudden existential crisis.  Will my life ever be the same?  How can I cope with all this new suffering? In the latter, there is often a sense of failure or overwhelm; typically, a lack of social resources play a role. My patients face serious challenges and need more than simply medicines to temporarily address their illness.

What types of social prescriptions (e.g., arts, nature, volunteering) are referred, and who makes the referrals?

With my colleagues at UC Berkeley’s Great Good Science Center, I made some “old school” paper prescriptions for 10 activities for which there is evidence. Doing them can lead to measurable physiological benefits. This list includes giving someone a hug (we usually knock this one out on the spot!), talk to yourself in a kinder voice, call an old friend (I ask who that will be), help a friend in need, write a thank you note, etc.

I write in something as well.  I almost always write “Spread the Love” reminding them that love makes us live longer and richer lives. Often, too, I write “Look for Beauty!” When we spend a moment to take in something we find beautiful, for a couple of minutes  we feel more connected to the universe and drop our internal dialogues which typically just add to our suffering.

How is your program funded?

There is no cost for my program other than the cost of the paper prescription which I have made myself!  Reach out to me if you want help doing the same.

How has social prescribing impacted the health and well-being of the people you serve and which outcome measures do you use to measure that impact?

Given I only see hospitalized patients and do not see folks in follow up, I have limited data of the impact of the prescriptions. I have the immediate reaction. I have given out hundreds if not thousands of these and only once or twice were received with indifference. Almost always the prescription is received with surprise then joy! People expect a prescription for a cholesterol or blood pressure medicine and are confused for a second and then a smile appears and a brief but lively conversation ensues.

Research would suggest these prescriptions should be beneficial for several reasons.  Especially for vulnerable people, it is easy to feel like cogs in the medical industrial complex. If  the provider asks them what matters to them and their doc’s idea of health and wellbeing is in line with what they intuit about their health, trust is established. Trust is an important predictor of health outcomes - better medication compliance, follow up visits, etc.

Receiving this prescription is a rare opportunity to reflect on what really matters to them and what their health and age have made them lose touch with - music, church, simply getting out into the fresh air. Living a more connected, meaningful life has measurable health effects. These are moving moments for doc and patient alike.

I do have occasional follow up visits when my patient is readmitted to the hospital.  I will hear:

•  “That prescription got a lot of likes!” ( no one's prescriptions for water pills never end up on social media)

• “My pastored loved it and talked about it at church”

• “ Hey, it is Dr. Love again”

I have had a couple people in tears tell me our conversation and the prescription helped them get sober. I had never seen a patient doing a Zoom Alcoholic Anonymous meeting in the hospital before, but one prescription produced that.

Another man credits the prescription for “riding his bike to watch the sunset” with saving his life.  That activity helped lift his depression, stop using cocaine and take his heart meds.  This time the tears were mine.

What advice would you give to others looking to start a social prescribing program?

In a high burnout field, I love my job. No doubt, giving these prescriptions are a reason.  They connect me with my patients in ways I otherwise would not. It is this connection more than the diagnostic process that brings deep satisfaction.

Time is the currency for health care providers. We need to be cautious with it but not miserly. I will hand out about 2 of these a day to the appropriate patients who are leaving the hospital. In total this adds 5-10 minutes max to my day.  Given the rewards in terms of reduced burnout, it is time well spent.

My advice to people considering a social prescribing program: Yes, ideally you would have infrastructure and funding to direct our patients to the resources they need. Yes, our health care system doesn’t seem to get it - and in doing so lets down the docs and patients like, but to start all you need is a little curiosity and a desire to give your patients what they actually need. You will enjoy your work much more. Pick your patients carefully and the rewards will be rich and the time well spent limited.