Are you lonely? Primary care docs should ask this question.

A commentary discusses the U.S. Surgeon General’s advisory that clinicians broach this topic with patients.

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Dr. Sebastian Tong, a family medicine physician, asks the usual questions when he sees his patients: Blood pressure, check. Heart rate, check. Vaccinations and exercise, check.

But lately, Tong, a UW Medicine physician who practices at Harborview Medical Center, tacks on another query: Are you lonely? Patients may be surprised.  But some are grateful.

“Not everyone is open to talking about it,” Tong said. “But some are.”

Whatever the answer, primary-care physicians should add this question to their checklist, even in the tight 15 minutes of most appointments, he said. 

“I think loneliness should be incorporated into healthcare and into primary care, because of how much it affects health. We're seeing the prevalence is much higher than many chronic diseases.”

Tong and coauthors recently explored this issue in a recommendation that appeared in the Annals of Family Medicine. 

The commentary supported the U.S. Surgeon General Dr. Vivek Murthy’s 2023 advisory recommending that doctors start asking these questions, that training be offered to physicians to ask and respond effectively, and that patients be assisted in finding resources to deal with social isolation. Citing one study, Murthy declared loneliness and isolation an epidemic whose health impacts have been likened to smoking up to 15 cigarettes a day.

Primary-care physicians should specifically ask these questions of young adults, as well as seniors and any patients who has lost a partner or spouse, recently relocated or experienced another major life change. 

“Among age groups, we know that you see a spike in loneliness in young adulthood and also in those who are elderly or recently retired,” Tong said. 

In the commentary, Tong and coauthors offer solutions drawn from UK models that incorporate ideas such as cognitive behavioral therapy and using a social navigator to connect patients with community-based programs. 

Across a lifespan, the authors noted, the prevalence of loneliness is remarkably high, with recent estimates suggesting that nearly 50% of all Americans are lonely.  One Cigna study put that number at 61%. The same Cigna study found that 79% of young adults 18 to 22 said they are lonely. 

Prior to the COVID-19 pandemic, nearly 20% of primary-care patients self-identified as lonely —more than patients who had obesity, depression or diabetes. 

Social isolation has been associated with an increased risk of early death, a 50% increased risk of dementia, 29% increased risk of heart disease and 32% increased risk of stroke in older adults, according to the Centers for Disease Control and Prevention.

“From my clinical experience, people come in with, for example, uncontrolled diabetes, and when I get down to the root of it, they're living alone, they're spending most of their time alone, and they aren't able to motivate themselves to exercise or get healthy food,” Tong said.

“While all healthcare professionals will encounter patients who are lonely or social isolations, it is particularly true in primary care, which is the front line of healthcare for most Americans,” the authors wrote. 


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