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Editor's Commentary on 'From Delhi Slums to Los Angeles Wards: Lessons from a Year Working Against Sex Trafficking'

 , May 29, 2015

In recent years there has been increasing emphasis on the use of patient- or relationship-centered approaches to patient care. We are encouraged to care for the whole person rather than simply treating the collection of signs and symptoms before us. A key component of caring for the entire patient is obtaining a good social history. Though this portion of the history often is restricted to hurried inquiries about tobacco, alcohol, and illicit drug use, a more comprehensive social history can provide context for the history of present illness, suggest differential diagnoses we might not have otherwise considered, and help us build rapport with our patients. For these reasons, some have suggested adopting a “reverse history” approach to patient encounters, beginning with the social history and finishing with the history of present illness.1

In his essay “From Delhi Slums to Los Angeles Wards: Lessons from a Year Working Against Sex Trafficking,” Abraar Karan describes a similar approach that he utilized during his time in India working to dismantle the sex trafficking industry. He begins by obtaining a collective social history of sorts, listening to the stories of victims of sex trafficking, sex workers, brothel owners, pimps, johns, and traffickers. Karan’s genuine interest and willingness to listen with an open mind allowed him to gain the trust and respect of the people he was trying to assist, while the stories themselves helped Karan to learn about the culture of the sex industry and the environment in which these individuals lived and worked. These efforts in turn shaped the development and implementation of several culturally appropriate and sustainable employment, health education, and care delivery initiatives.

Ultimately, as Karan tells us, it’s “about people.” Taking a good social history or, more broadly, listening to people’s stories can help to set the context for more fulfilling and productive relationships with patients and clients. Grounding ourselves in these relationships will make us better doctors, teachers, and NGO volunteers (or more effective in whatever other roles we may choose to assume).

Rachel Elkin      


Wu BJ. History taking in reverse: beginning with the social history. Consultant. 2013; 53(1): 34-36.