Social medicine

Question 1

Dialogic praxis

Answer 1

clinicians and patients engage in bidirectional critical analysis and learning. Dialogic approaches can
be therapeutically beneficial because they help identify new problem-solving knowledge and are aimed at altering specific features of a patient’s social world.

Question 2

Structural Differential

Answer 2

A structural differential delineates the social, political, and economic factors that may be influencing a patient’s health and health care and facilitates responses to the modifiable factors.

Question 3

Steps in Generating and Refining a Structural Differential.

Answer 3

1. Intentionally expand the scope of clinical inquiry to include structural factors.
2. Use tools such as the structural vulnerability checklist to frame and inform a
   broad list of hypotheses.
3. Gather perspectives from outside the exam room.
4. Learn about the historical context.
5. Partner with patients in their communities to clarify and prioritize relevant issues
   and actions.

Question 4

Structural racism

Answer 4

refers to the ways in which historical and contemporary racial in- equities in outcomes are per- petuated by social, economic, and political systems, includ- ing mutually reinforcing sys- tems of health care, educa- tion, housing, employment, the media, and criminal jus- tice. It results in systemic variation in opportunity ac- cording to race or ethnic background — for example, in racial differentials in ac- cess to health care.

Question 5

Medicalization and Demedicalization

Answer 5

Demedicalization is the transformation of prob- lems formerly understood to be medical in nature into problems understood to be nonmedical.
Like its opposite, medi- calization, demedicaliza- tion occurs at multiple lev- els, ranging from the con- ceptualization of etiology to the understanding of whether interventions for problems are appropriately medical or nonmedical.

Question 6

classification

Answer 6

understand the world by dividing it into digestible, often binary categories. In medicine, classification pro- vides powerful tools for diag- nosis. However, classifica- tions — including those of race and sex — often fail to capture complexity, prevent- ing practitioners from taking the best course of action.

Question 7

Clinical Implications of classification

Answer 7

Clinicians can begin by recognizing the limitations of implicit classification algorithms.

Question 8

Misrecognition

Answer 8

refers to an inaccurate or incomplete appraisal of the causes of a social problem because of assumptions learned through every- day social interactions. Misrecogni- tion often causes us to see aspects of the social world as natural or normal and to take them for granted.1
“Critical consciousness,” a con- cept from Freire, refers to a capacity that can be developed by community members, including those who are marginalized, to perceive, analyze, and respond to the social forces af- fecting their day-to-day lives.2

Question 9

Social distance

Answer 9

“Social distance” is the gap created by marked differences (cultural, socioeconomic, lin- guistic, etc.) between groups of people, even if they inhabit overlapping geographic areas. The term is used to identify clinically significant differ- ences between the life of
the imagined patient whom a health care institution is designed to serve and a par- ticular patient’s actual life.

Question 10

Clinical Implications: Recognizing and Engaging with Social Distance

Answer 10

Identify and address social distance
Treat mobility as the norm.
Utilize bridge case management.