For years, Laura Porterfield, MD, has helped patients in her primary care practice navigate not only medical conditions but also the life circumstances that can impact their health.
Now, the University of Texas Medical Branch (UTMB Health) family medicine physician is bringing those insights to a national audience as lead author of a study published in the July/August issue of Annals of Family Medicine that examines 12 paradoxes shaping the growing field of social care in primary care.
The article, “The Paradoxes of Social Care: Reframing Apparent Conflicts,” grew out of a broader systematic review conducted by Porterfield and colleagues to better understand the facilitators and barriers to integrating social care into primary care.
“As we reviewed the literature, we noticed a recurring pattern: Many of the debates surrounding social care appeared to involve competing viewpoints that were both valid,” Porterfield said.
Rather than viewing those tensions as obstacles, the researchers reframed them as paradoxes, apparent contradictions in which both perspectives can be true.
“These are situations where people often feel they have to choose one side or the other, but when you look more deeply, both things can be true at the same time,” she explained.
The growing emphasis on social care stems from a large body of research showing that healthcare is only one factor influencing health outcomes. While genetics and clinical care play important roles, social and environmental factors such as access to healthy food, reliable transportation, stable housing, neighborhood safety, and green spaces can significantly affect a person’s health and life expectancy.
As healthcare organizations increasingly seek ways to address those factors, primary care has emerged as a natural setting for identifying social needs and connecting patients with support resources.
“Primary care is a place where we get to know patients over time and understand the context of their lives,” Porterfield said. “That creates opportunities to better understand barriers that may be affecting their health and their ability to access care.”
One paradox highlighted in the paper involves patient discomfort when discussing social needs.
“Research has shown that some patients may feel embarrassed when asked about challenges such as food insecurity or difficulty paying bills,” she said.
At the same time, studies suggest that when screening is conducted respectfully and routinely, it can normalize those conversations and strengthen trust.
“Screening for social needs can amplify shame if it's not done well,” Porterfield continued. “But it can also reduce shame because patients no longer have to ask for help. The support is offered to everyone as a regular part of their care.”
Another paradox centers on clinician burnout. Asking patients about unmet social needs can create distress if healthcare teams lack resources to address identified problems.
Yet the same work can increase professional satisfaction when clinicians are supported by social workers, community health workers, and other team members who can help connect patients with meaningful assistance.
“Doing this work alone can be overwhelming,” Porterfield said. “When it's approached as a team effort, it can become one of the most rewarding aspects of caring for patients.”
The paper also explores the tension between evidence-based medicine and adapting care to real-world circumstances. Clinical guidelines may recommend multiple medications or interventions, but patients sometimes face financial barriers, transportation challenges, or other obstacles that make following those recommendations difficult.
“If a patient can’t afford every medication that’s recommended, we need to understand that reality and work with them,” Porterfield said. “Sometimes adapting care to a patient’s circumstances is the best way to achieve meaningful health outcomes.”
The researchers found that many social care challenges can be better understood through three broad approaches: recognizing that perfect should not be the enemy of good, considering different perspectives, and understanding how context influences experiences.
Some clinicians hesitate to screen for social needs because they believe they cannot fully solve every problem they uncover. Porterfield said even imperfect solutions can make a difference. Identifying transportation challenges may lead to telehealth visits. Recognizing food insecurity may allow clinicians to connect patients with local assistance programs. Understanding social circumstances can help healthcare teams tailor care in ways that are more realistic and effective.
“You don’t have to solve every problem to make just a bit of progress,” Porterfield said. “If we’re waiting for a perfect solution before we ask about social needs, we’re missing key opportunities to help patients.”
The research reflects broader efforts within the Department of Family Medicine at UTMB to integrate social care into clinical practice. Porterfield said the work has also influenced her own approach to patient care since she began intentionally focusing on social needs screening and support in 2022.
Today, she strives to ensure those conversations are respectful, empowering, and centered on understanding the full picture of a patient’s life.
“My goal is to understand my patients' circumstances in a way that helps them feel supported, not judged,” Porterfield said. “When we understand more about what people are facing outside the clinic, we're often better able to help them inside the clinic as well.”
For Porterfield, the study’s most important contribution may be helping healthcare professionals move beyond either-or thinking in a field that is inherently complex.
“When issues are viewed in black-and-white terms, it’s easy to become stuck,” she said. “Understanding the nuances allows us to move forward and provide better care for our patients.”