At your annual exam, more doctors are starting to screen for what the stethoscope misses: loneliness

A new health topic may soon be included in your routine primary care visit: loneliness.

U.S. Surgeon General Vivek Murthy said in May that the “epidemic of loneliness and isolation has been an underappreciated public health crisis.”

Murthy followed by urging the country to address the “crisis” with the same level of effort expended on diseases like obesity and substance abuse.

Sebastian Tong, a family physician and addiction medicine specialist at the University of Washington, said doctors should talk about patients’ feelings of isolation along with other medical concerns.

“Loneliness should be incorporated into health care,” Tong said. “We’re seeing the prevalence is much higher than many chronic diseases.”

Mental health has taken center stage as a public health concern in recent years, but the new fear is that physicians may screen more for anxious, depressive or suicidal thoughts and behaviors, while neglecting how often a patient interacts with others.

New data from the U.S. Centers for Disease Control and Prevention highlighted that loneliness is not only becoming more common, it’s associated with early onset of severe medical conditions and worse outcomes for those already ill.

The CDC cited a 2020 study that found that patients with heart failure who also reported loneliness faced a “nearly 4 times increased risk of death, 68% increased risk of hospitalization, and 57% increased risk of emergency department visits,” when compared to participants with the same health conditions who weren’t isolated.

A June 2023 study published in the journal Nature Human Behaviour noted that “social isolation and loneliness were significantly associated with an increased risk of all-cause mortality,” including from cancer.

People with “more difficult socio-economic circumstances” are more likely to feel lonely, according to Dr. Michael Kerkering, a Providence internal medicine specialist who assists with educating medical students and resident physicians.

Bethann Gurrad, a licensed mental health counselor at MultiCare Rockwood Behavioral Health Primary Care Access Clinic in Spokane, said it’s important for caregivers to address loneliness.

“Loneliness is a survival mechanism,” she said. “The whole idea that somebody has your back is hundreds of thousands of years old.”

Gurrad said there’s a relationship between loneliness and life span, but in spite of this, the screenings upon which she relies often gloss over social isolation.

The Patient Health Questionnaire (PHQ-9), for example, is a mental health-focused diagnostic form. It was originally created by Pfizer in 1999 and includes nine prompts with an opportunity for patients to rate the frequency at which they experience certain feelings.

“Poor appetite or overeating” and “trouble concentrating” are a couple of the featured phrases. Loneliness, however, is not on the questionnaire.

Gurrad said adding another question about loneliness to commonly used screenings may prove beneficial.

Dr. Darryl Potyk, associate dean for Eastern Washington at the University of Washington School of Medicine and a practicing internist, also said depression and anxiety disorder screening has become routine, alongside cancer, health maintenance and vaccination histories. Inquiries on loneliness are less common, though.

While he believes physicians may be overlooking loneliness in the absence of a specific question for patients, Potyk hopes a “long-term, longitudinal relationship” and adopting a philosophy of treating the person beyond a disease may allow the patient’s social habits to come to light.

Rather than asking directly about loneliness, he seeks to learn “the sensitive information from patients in a way that is respectful” and dignifying, he said.

“I ask them how they spend their day, and that’s a very revealing question,” Potyk said.

When a patient shows signs of extended social isolation, his concerns increase.

One challenge when checking a patient for loneliness is that “the burden of this type of screening falls almost entirely upon primary care physicians,” Kerkering said in an email.

While Gurrad, the counselor, typically spends 40 to 55 minutes with a patient, a study published in Medical Care found primary care doctors spend 18 minutes on average.

Both Kerkering and Gurrad focused on the challenge of connecting patients with providers.

Having an integrated system would allow primary care to easily refer patients elsewhere without imposing barriers, experts said. MultiCare is one of the many medical groups working to achieve this seamless experience for patients by employing a system of “collaborative care,” according to Gurrad.

Roy Cantu, the senior medical director at CHAS Health and a physician assistant-certified, thinks medicine, especially the way in which providers diagnose and treat mental health, has come a long way.

“Back in the day,” he said, “we were more reactive.” Now, Cantu said, “it’s a great opportunity to be more proactive.”

Potyk believes the future of medicine should include strong partnerships within health care teams. He also stated that the role of a care navigator for diseases like cancer may be applicable to lonely patients.

Ultimately, the physician of 35 years said, loneliness “is changing the paradigm in which we practice.”