""whom you could count on in time of need...?"

I have dabbled in social support interventions over the years through the Pittsburgh Caregiver Support Network, involvement with patient navigator/advocacy activities and peer support groups but a phone call with a patient earlier today brought reality to a complex issue in American society.  I called my patient whom I've known for over 10 years to inform her that the blood culture obtained the day before from urgent care has turned positive and that she needed to be directly admitted.  Her partner completely broke down on the phone.  Through the anger and despondent sobbing, I could make out: who is going to watch our daughter...you know you can't trust leaving L. in the hospital without someone watching over her.  They'll give her the wrong medications...and it's July, all those new interns...and my mother, I have to take care of my mother.  Can you arrange for the antibiotics at home...will the ID doc see her on a holiday?  Dozens of questions hurled at me, most of which I do not have answers although I do know that I could get more blood culture drawn, IV line and empiric antibiotics started in the hospital.  Could I say for certain that she would be safer in the hospital than at home?  guilt and embarrassment choked up inside me...

What my patient and her partner need is what is labeled an informal social support--family, friends and trustworthy sources.  A formal social support, in contrast, is usually more bureaucratized, stigmatizing, costly, less personalized and accessible.  How do you engender trust and perception of support in formal social support network?  How do we promote public policy that build family social support?  These are some of the programs compiled by the RWJF and County Health Rankings & Roadmaps.