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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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52. Structural Injustice
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A fool contributes nothing worth hearing and takes offense at everything.
~ Aristotle
Injustice Unveiled
Fighting Against Structural Injustice in Healthcare
Dr. Emily Scott, a young and brilliant physician, had just finished her residency and landed a job at a prestigious hospital in a wealthy neighborhood. She was excited to start her career, but it wasn’t long before she noticed something strange.
Patients from certain ethnic and racial backgrounds were consistently receiving lower quality care than others. They were more likely to be misdiagnosed, receive incorrect treatment, and suffer negative health outcomes.
Dr. Scott began to investigate and soon discovered that the hospital had a long history of structural injustice. The hospital had a hiring policy that favored certain ethnic and racial groups, and patients from these groups were more likely to receive specialized care and have access to the latest medical technology.
Dr. Scott was appalled by this and felt compelled to do something about it. She began to speak out against the hospital’s practices and organized her colleagues to demand change.
However, her actions were met with resistance. The hospital’s management accused her of causing trouble and spreading false accusations. Dr. Scott was undeterred and continued to push for change, but the hospital’s management refused to listen.
One day, Dr. Scott was found dead in her office. The cause of death was determined to be a drug overdose, but her colleagues were suspicious. They believed that Dr. Scott had been murdered because of her activism against the hospital’s practices.
The investigation into her death uncovered a conspiracy involving the hospital’s management and several influential members of the community. They had conspired to silence Dr. Scott because they saw her as a threat to their power and influence.
In the end, justice was served, and the hospital’s practices were exposed. The community came together to demand change, and Dr. Scott’s legacy inspired a new generation of medical professionals to fight against structural injustice and work towards a more equitable healthcare system.
Abstract
Structural injustice has significant effects on healthcare disparities. Structural injustice refers to social, political, and institutional practices that result in unequal effects on individuals due to their membership in a certain social group. It is strongly linked to group identity and can manifest in inequalities in education, opportunity, wealth, political representation, and access to medical care. It is imperative that society, the medical professionals and medical practitioners recognize the unity of humanity in combating structural injustice. The patient-practitioner relationship is also impacted by structural injustice, which can affect informed consent and the principles of beneficence and nonmaleficence in medical practice. The importance of the principle of justice and the role of a democratic constitutional republic in promoting fairness and structural alignment in government cannot be over stressed. The four principles of biomedical ethics, like a democratic constitutional republic, require structural checks and balances to ensure ethical practice.
**
Think
[52:1] Structural injustices are social, political, and institutional practices that result in different and sometimes unjust effects on individuals because they are members of some identifiable social group. Examples of structural injustice are:
- 1. inequality of education,
- 2. inequality of opportunity,
- 3. inequality of wealth,
- 4. inequality of political representation, and,
- 5. inequality of access to medical care.
[52:2] Structural injustice is strongly associated with group identification. When a person’s group identity such as politics, ethnicity, religion, or socially constructed race determinations becomes a significant part of a person’s identity, then the result can be social injustice if social benefits go to the tribal “us(es)” at the expense or burdens of the tribal “them(s).”
[52:3] Society and the medical professions must continually focus on how all persons are part of the unified social group of one humanity if there is going to be any chance of eliminating or even mitigating structural injustice with its resultant healthcare disparities.
[52:4] Structural injustice begins before initiating the patient-practitioner relationship, such as with education, employment, housing, diet, exercise, sleep, tobacco-alcohol-coffee and drug use, clothing, relationships, sexuality, leisure, transportation, social entitlements, and health insurance.
[52:5] When first establishing the patient-practitioner relationship, the patient is expected to provide a complete history and allow a complete physical. The practitioner is then expected to objectively interpret this protected health information (PHI) for prevalence rate risk determinations and the possible identification of disease and afflictions. Structural injustice affects both the patient and the practitioner in the patient-practitioner relationship. Because of this, some have argued for racial concordance, in which patients and practitioners choose to have patient-practitioner relationships primarily with those who have the same phenotypic and ethnic similarities as themselves. Some think that racial concordance will promote trust, understanding, and empathy resulting in better healthcare outcomes. Others think that racial concordance results in unacceptable segregation and increased healthcare disparities as discussed in Topic 41. Racial Concordance. Concerning racial concordance, it is essential to remember that there is no ethically reciprocal option for the practitioner to choose racially concordant patients.
individual rights and liberties that patients have in selecting their practitioner are not reciprocal. Practitioners, as a profession, do not have the right or liberty to select patients based on phenotype or culture. [41:5]
Assess
Patient: 1) Autonomy
[52:6] For the patient to be able to provide autonomous informed consent, it requires:
- 1. patient’s trust in the unbiased knowledge and skills of the practitioner to provide an accurate diagnosis, prognosis, and treatment plan, and
- 2. the practitioner trusts that the patient is disclosing openly and honestly all necessary information for the practitioner to make a proper diagnosis, prognosis, and treatment plan.
[52:7] Recognizing these two necessary conditions clarifies why informed consent is considered a joint decision-making process between the patient and the practitioner. Informed consent output can only be as good as the informed consent input, and the degree to which structural injustice affects not only the input but also the output shows how profound a problem structural injustice influences can be when trying to attain autonomous informed consent.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[52:8] The medical professional’s prime directive is to maximize the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities. Ideally, the patient’s best interests are determined by the autonomous informed consent of the patient. Practically, as medicine becomes more complex and technologically complicated, the practitioner’s expert knowledge and experience are indispensable for attaining the patient’s best interests. This prime directive is attained when there is an alignment with the two professional principles of beneficence (do good) and nonmaleficence (do no harm). Implicit is that when fulfilling either of the professional principles, it implies, or results in, the fulfilling of the other principle.
[52:9] Structural injustice is core to the collapse of the patient-practitioner relationship, the practitioner’s failure to determine what the patient’s reasonable goals, values, and priorities are, and the diminished ability to maximize the patient’s best interests using the principles of beneficence (do good) and nonmaleficence (do no harm).
Public Policy: 4) Justice
[52:10] Structurally, the United States is not a democracy per se; rather, the United States is a democratic constitutional republic. Pure democracies tend to become the tyranny of the majority. Constitutions provide minority protections from the tyranny of the majority. A republic elects qualified representatives to champion the interests of its constituents. Together this becomes a democratic constitutional republic that is more just (fair) than any one characteristic by itself. In other words, structural checks and balances are needed to keep each branch of government in structural alignment.
[52:11] The executive, legislative, and judicial branches each have their powers and responsibilities. Unfortunately, these structural checks and balances can be corrupted with concerted political effort. When one branch of government is exercised without the checks and balances of the other branches of government, this is known as political structural injustice.
[52:12] Each of the four principles of biomedical ethics, like a democratic constitutional republic, are necessary structural checks and balances on each other. Emphasizing one moral principle at the expense of the others can result in unaccepted moral consequences, resulting in structural injustice with its resultant healthcare disparities.
Conclude
[52:13] When communicating with patients, medical practitioners must always stay neutral concerning politics, religion, gender identity, and other socially divisive issues. All patients need to feel that they are in a safe and neutral location. Structural injustice in healthcare occurs whenever there is unequal and unfair distribution of healthcare benefits and burdens. Since equality of medical access and treatment is ideal, practitioners must always promote moving closer to that end.
[52:14] In summary, structural healthcare injustice, refers to social, political, and institutional practices that result in unequal effects on individuals due to their membership in a certain social group, resulting in significant effects on healthcare disparities. Society, medical professionals, and practitioners must recognize the unity of humanity in combating structural injustice to eliminate or mitigate healthcare disparities. The patient-practitioner relationship is impacted by structural injustice, which can affect informed consent and the principles of beneficence and nonmaleficence in medical practice. A democratic constitutional republic is essential in promoting fairness and structural alignment in government, and each of the four principles of biomedical ethics are necessary structural checks and balances on each other. Medical practitioners should stay neutral on socially divisive issues and instead promote moving closer to equality of medical access and treatment.
(See also 41. Racial Concordance)
**
52. Review Questions
1. Structural injustices are social, political, and institutional practices that result in different and sometimes unjust effects on individuals because they are members of some identifiable social group.
2. When a person’s group identity such as politics, ethnicity, religion, or socially constructed race determinations becomes a significant part of a person’s identity, then the result can be social injustice if social benefits go to the tribal “us(es)” at the expense or burdens of the tribal “them(s).”
3. Some think that racial concordance will promote trust, understanding, and empathy resulting in better healthcare outcomes. However, nobody thinks that racial concordance results in unaccepted segregation and increased healthcare disparities.
4. Informed consent output can only be as good as the informed consent input, and to the degree to which structural racism affects not only the input but also the output shows how profound a problem structural injustice influences can be when trying to attain an autonomous informed consent.
5. Structural injustice is core to the collapse of the patient-practitioner relationship, the practitioner’s failure to determine what the patient’s reasonable goals, values, and priorities are, and the diminished ability to maximize the patient’s best interests through the use of the principles of beneficence (do good) and nonmaleficence (do no harm).
6. When one branch of government is exercised without the checks and balances of the other branches of government, this is known as political structural injustice. This has a direct parallel in balancing the principles of bioethics.
**
CORRECT! 🙂
[52:1] Structural injustices are social, political, and institutional practices that result in different and sometimes unjust effects on individuals because they are members of some identifiable social group. Examples of structural injustice are:
1. inequality of education,
2. inequality of opportunity,
3. inequality of wealth,
4. inequality of political representation, and,
5. inequality of access to medical care.
Wrong 😕
[52:1] Structural injustices are social, political, and institutional practices that result in different and sometimes unjust effects on individuals because they are members of some identifiable social group. Examples of structural injustice are:
1. inequality of education,
2. inequality of opportunity,
3. inequality of wealth,
4. inequality of political representation, and,
5. inequality of access to medical care.
Wrong 😕
[52:2] Structural injustice is strongly associated with group identification. When a person’s group identity such as politics, ethnicity, religion, or socially constructed race determinations becomes a significant part of a person’s identity, then the result can be social injustice if social benefits go to the tribal “us(es)” at the expense or burdens of the tribal “them(s).”
CORRECT! 🙂
[52:2] Structural injustice is strongly associated with group identification. When a person’s group identity such as politics, ethnicity, religion, or socially constructed race determinations becomes a significant part of a person’s identity, then the result can be social injustice if social benefits go to the tribal “us(es)” at the expense or burdens of the tribal “them(s).”
Wrong 😕
[52:4] When first establishing the patient-practitioner relationship, the patient is expected to provide a complete history and allow a complete physical. The practitioner is then expected to objectively interpret this protected health information (PHI) for prevalence rate risk determinations and the possible identification of disease and afflictions. Structural injustice affects both the patient and the practitioner in the patient-practitioner relationship. Because of this, some have argued for racial concordance, in which patients and practitioners choose to have patient-practitioner relationships primarily with those who have the same phenotypic and ethnic similarities as themselves. Some think that racial concordance will promote trust, understanding, and empathy resulting in better healthcare outcomes. Others think that racial concordance results in unaccepted segregation and increased healthcare disparities as discussed in Topic 41. Racial Concordance. Concerning racial concordance, it is essential to remember that there is no ethically reciprocal option for the practitioner to choose racially concordant patients.
individual rights and liberties that patients have in selecting their practitioner are not reciprocal. Practitioners, as a profession, do not have the right or liberty to select patients based on phenotype or culture. [41:5]
CORRECT! 🙂
[52:4] When first establishing the patient-practitioner relationship, the patient is expected to provide a complete history and allow a complete physical. The practitioner is then expected to objectively interpret this protected health information (PHI) for prevalence rate risk determinations and the possible identification of disease and afflictions. Structural injustice affects both the patient and the practitioner in the patient-practitioner relationship. Because of this, some have argued for racial concordance, in which patients and practitioners choose to have patient-practitioner relationships primarily with those who have the same phenotypic and ethnic similarities as themselves. Some think that racial concordance will promote trust, understanding, and empathy resulting in better healthcare outcomes. Others think that racial concordance results in unaccepted segregation and increased healthcare disparities as discussed in Topic 41. Racial Concordance. Concerning racial concordance, it is essential to remember that there is no ethically reciprocal option for the practitioner to choose racially concordant patients.
individual rights and liberties that patients have in selecting their practitioner are not reciprocal. Practitioners, as a profession, do not have the right or liberty to select patients based on phenotype or culture. [41:5]
Wrong 😕
[52:6] Recognizing these two necessary conditions clarifies why informed consent is considered a joint decision-making process between the patient and the practitioner. Informed consent output can only be as good as the informed consent input, and the degree to which structural injustice affects not only the input but also the output shows how profound a problem structural injustice influences can be when trying to attain autonomous informed consent.
CORRECT! 🙂
[52:6] Recognizing these two necessary conditions clarifies why informed consent is considered a joint decision-making process between the patient and the practitioner. Informed consent output can only be as good as the informed consent input, and the degree to which structural injustice affects not only the input but also the output shows how profound a problem structural injustice influences can be when trying to attain autonomous informed consent.
CORRECT! 🙂
[52:9] Structural injustice is core to the collapse of the patient-practitioner relationship, the practitioner’s failure to determine what the patient’s reasonable goals, values, and priorities are, and the diminished ability to maximize the patient’s best interests through the use of the principles of beneficence (do good) and nonmaleficence (do no harm).
Wrong 😕
[52:9] Structural injustice is core to the collapse of the patient-practitioner relationship, the practitioner’s failure to determine what the patient’s reasonable goals, values, and priorities are, and the diminished ability to maximize the patient’s best interests through the use of the principles of beneficence (do good) and nonmaleficence (do no harm).
Wrong 😕
[52:11] The executive, legislative, and judicial branches each have their powers and responsibilities. Unfortunately, these structural checks and balances can be corrupted with concerted political effort. When one branch of government is exercised without the checks and balances of the other branches of government, this is known as political structural injustice.
CORRECT! 🙂
[52:11] The executive, legislative, and judicial branches each have their powers and responsibilities. Unfortunately, these structural checks and balances can be corrupted with concerted political effort. When one branch of government is exercised without the checks and balances of the other branches of government, this is known as political structural injustice.
52. Clinical Vignettes
1. Mr. Isaac Wong is a 56-year-old retired construction worker who presents to the emergency department with shortness of breath and chest pain. He reports that he has been feeling progressively more fatigued over the past few weeks and has been experiencing difficulty breathing even while at rest. His medical history is significant for hypertension, hyperlipidemia, and type 2 diabetes, for which he has been noncompliant with his medications. On examination, he is found to have a heart rate of 120 beats per minute, blood pressure of 150/90 mmHg, and an oxygen saturation of 88% on room air. His physical exam is notable for bilateral crackles on lung auscultation. A chest x-ray reveals bilateral pulmonary edema. The clinical differential diagnosis includes acute coronary syndrome, exacerbation of heart failure, and pneumonia. What ethical considerations should be taken into account in the management of Mr. Wong's care?
2. Mr. Ryan Smith, a 40-year-old African American man, works as a school teacher in a low-income community. He presents with uncontrolled hypertension, despite being on multiple antihypertensive medications. On further evaluation, he reveals that he struggles to afford healthy food and cannot afford to join a gym or hire a personal trainer due to financial constraints. He also reports that he has limited access to fresh produce in his neighborhood, and the only grocery store in the area sells mostly processed foods. He requests that his Practitioner prescribe him cheaper medications, but the Practitioner is concerned about the risk of adverse outcomes due to the potential side effects and drug interactions. The ethical question is: what is the most appropriate course of action in this situation?
3. Mr. David White, a 45-year-old African American man, presents to the clinic with a complaint of severe lower back pain that has been worsening for the past week. Mr. White reports that he has a history of hypertension and type 2 diabetes, which are well controlled with medication. His past occupation was as a construction worker. On examination, Mr. White is found to have limited range of motion in his lower back and tenderness to palpation in the lumbar region. Clinical differential diagnoses may include lumbar strain or sprain, herniated disc, or spinal stenosis. An ethical question in this case may be how structural injustice affects Mr. White's access to healthcare, and what can be done to address these disparities.
4. Ms. Eileen Park, a 28-year-old Korean-American woman, comes to the clinic with complaints of chronic back pain. She has been experiencing lower back pain for several months, and it has been affecting her ability to work as a physical therapist. She reports that she has tried over-the-counter pain medications and stretching exercises, but nothing seems to provide relief. On examination, the Practitioner notes that Ms. Park has limited range of motion in her back and moderate tenderness on palpation of the lumbar spine. Further evaluation with imaging studies reveals degenerative changes in her spine. During the consultation, Ms. Park expresses her frustration with the healthcare system, particularly with the perceived lack of cultural competence among healthcare providers. She shares that she has had negative experiences in the past where providers dismissed her symptoms or attributed them to cultural differences rather than providing adequate medical care. She also expresses concern that her ethnicity and cultural background may have played a role in her symptoms being overlooked. What is the ethical dilemma in this scenario?
5. Mr. Peter Johnson is a 45-year-old African American man who works as a schoolteacher. He presents to his primary care Practitioner with complaints of a persistent cough and shortness of breath for the past three months. He also reports having unintentional weight loss and fatigue. His medical history is significant for hypertension and asthma, which has been well-controlled for years. Upon further questioning, Mr. Johnson reports that he has been feeling increasingly stressed and anxious due to recent events in his community. He lives in a predominantly African American neighborhood that has been dealing with issues of gentrification and displacement. He feels that his community is being pushed out in favor of more affluent and predominantly White residents. He also feels that his concerns and those of his community are being ignored by the local government. Mr. Johnson's symptoms could be related to his asthma or could be indicative of a more serious underlying condition, such as lung cancer. However, his stress and anxiety related to the social injustices in his community could also be contributing to his symptoms. The ethical question is: How can healthcare providers address the impact of social injustice on their patients' health and well-being?
CORRECT! 🙂
Explanation: Structural injustice refers to social, political, and institutional practices that result in unequal effects on individuals due to their membership in a certain social group. In healthcare, this can lead to healthcare disparities and unequal access to medical care [52:1]. The patient-practitioner relationship is also impacted by structural injustice, which can affect informed consent and the principles of beneficence and nonmaleficence in medical practice [52:4, 52:8, 52:9]. While patient autonomy and practitioner beneficence are important ethical considerations in medical care, addressing structural injustice in healthcare is necessary to ensure equitable access to medical care and reduce healthcare disparities [52:3, 52:13]. Racial concordance has been suggested as a means to promote trust and empathy between patients and practitioners, but this approach may result in unacceptable segregation and increased healthcare disparities [52:5]. Therefore, the correct answer is, the need to address structural injustice in healthcare to ensure equitable access to medical care.
Wrong 😕
Explanation: Structural injustice refers to social, political, and institutional practices that result in unequal effects on individuals due to their membership in a certain social group. In healthcare, this can lead to healthcare disparities and unequal access to medical care [52:1]. The patient-practitioner relationship is also impacted by structural injustice, which can affect informed consent and the principles of beneficence and nonmaleficence in medical practice [52:4, 52:8, 52:9]. While patient autonomy and practitioner beneficence are important ethical considerations in medical care, addressing structural injustice in healthcare is necessary to ensure equitable access to medical care and reduce healthcare disparities [52:3, 52:13]. Racial concordance has been suggested as a means to promote trust and empathy between patients and practitioners, but this approach may result in unacceptable segregation and increased healthcare disparities [52:5]. Therefore, the correct answer is, the need to address structural injustice in healthcare to ensure equitable access to medical care.
CORRECT! 🙂
Explanation: The most appropriate course of action in this scenario would be to refer the patient to a social worker to explore financial assistance for healthy lifestyle interventions [52:2]. Structural injustices, such as inequality of wealth and access to healthy food options, can result in healthcare disparities and negatively impact patients' health outcomes. In this case, Mr. Smith is experiencing these structural injustices, which are contributing to his uncontrolled hypertension [52:4]. Prescribing cheaper medications may not address the root cause of his health issues and may potentially result in adverse outcomes due to drug interactions and side effects [52:7]. Similarly, offering resources for finding healthy food options and exercise programs may not be practical for patients experiencing financial constraints [52:4]. While discussing the importance of the current medications and their potential benefits is important, it may not be sufficient to address the patient's overall health needs. Referring the patient to a social worker can help address the structural injustices contributing to his health issues and facilitate access to resources for healthy lifestyle interventions, which can ultimately improve his health outcomes. [52:2, 52:4]
Wrong 😕
Explanation: The most appropriate course of action in this scenario would be to refer the patient to a social worker to explore financial assistance for healthy lifestyle interventions [52:2]. Structural injustices, such as inequality of wealth and access to healthy food options, can result in healthcare disparities and negatively impact patients' health outcomes. In this case, Mr. Smith is experiencing these structural injustices, which are contributing to his uncontrolled hypertension [52:4]. Prescribing cheaper medications may not address the root cause of his health issues and may potentially result in adverse outcomes due to drug interactions and side effects [52:7]. Similarly, offering resources for finding healthy food options and exercise programs may not be practical for patients experiencing financial constraints [52:4]. While discussing the importance of the current medications and their potential benefits is important, it may not be sufficient to address the patient's overall health needs. Referring the patient to a social worker can help address the structural injustices contributing to his health issues and facilitate access to resources for healthy lifestyle interventions, which can ultimately improve his health outcomes. [52:2, 52:4]
CORRECT! 🙂
Explanation: Mr. White's symptoms may indicate a serious underlying condition that requires further evaluation and management by a specialist [52:1]. Structural injustice can impact access to healthcare for marginalized groups such as African Americans, who may face barriers such as lack of health insurance, inadequate healthcare facilities in their communities, and implicit bias in the healthcare system [52:2-3]. It is important to recognize and address these disparities to ensure equitable access to healthcare for all individuals. The other options are incorrect because they do not address Mr. White's symptoms appropriately and may be influenced by assumptions or biases related to his race or occupation [52:1-3].
Wrong 😕
Explanation: Mr. White's symptoms may indicate a serious underlying condition that requires further evaluation and management by a specialist [52:1]. Structural injustice can impact access to healthcare for marginalized groups such as African Americans, who may face barriers such as lack of health insurance, inadequate healthcare facilities in their communities, and implicit bias in the healthcare system [52:2-3]. It is important to recognize and address these disparities to ensure equitable access to healthcare for all individuals. The other options are incorrect because they do not address Mr. White's symptoms appropriately and may be influenced by assumptions or biases related to his race or occupation [52:1-3].
CORRECT! 🙂
Explanation: The ethical dilemma in this scenario is that Ms. Park feels that her ethnicity and cultural background may have influenced her past experiences with healthcare providers, and she is concerned that this may continue to impact her medical care. [52:2] When a person's group identity becomes a significant part of their identity, social benefits may go to the tribal "us(es)" at the expense or burdens of the tribal "them(s)," resulting in social injustice [52:2]. The Practitioner has an ethical obligation to acknowledge Ms. Park's concerns [52:2] and address any possible biases or stereotypes that may have influenced her past experiences with healthcare providers [52:2]. By doing so, the Practitioner can help establish trust and rapport with the patient, which is essential for providing quality medical care. Dismissing Ms. Park's concerns or referring her to a provider solely based on her ethnicity would be inappropriate and could perpetuate the problem of social injustice [52:2].
Wrong 😕
Explanation: The ethical dilemma in this scenario is that Ms. Park feels that her ethnicity and cultural background may have influenced her past experiences with healthcare providers, and she is concerned that this may continue to impact her medical care. [52:2] When a person's group identity becomes a significant part of their identity, social benefits may go to the tribal "us(es)" at the expense or burdens of the tribal "them(s)," resulting in social injustice [52:2]. The Practitioner has an ethical obligation to acknowledge Ms. Park's concerns [52:2] and address any possible biases or stereotypes that may have influenced her past experiences with healthcare providers [52:2]. By doing so, the Practitioner can help establish trust and rapport with the patient, which is essential for providing quality medical care. Dismissing Ms. Park's concerns or referring her to a provider solely based on her ethnicity would be inappropriate and could perpetuate the problem of social injustice [52:2].
CORRECT! 🙂
Explanation: The correct answer is to address the patient's medical concerns while also recognizing the impact of social injustice on their health, and explore strategies for addressing both, as this response recognizes both the medical and social aspects of the patient's concerns and allows for a collaborative approach to address both issues [52:1]. Healthcare providers should be aware of the impact of social injustice on their patients' health and well-being and seek to address these issues in a sensitive and supportive manner [52:3]. In Mr. Johnson's case, his concerns about social injustices in his community may be contributing to his symptoms [52:2], and addressing only his medical concerns would not address the root cause of his distress. The other options do not address the potential impact of social injustice on his health, do not adequately address the patient's concerns, and although community activism may be helpful, healthcare providers should be careful not to impose their own values or beliefs on their patients [52:10, 52:12].
Wrong 😕
Explanation: The correct answer is to address the patient's medical concerns while also recognizing the impact of social injustice on their health, and explore strategies for addressing both, as this response recognizes both the medical and social aspects of the patient's concerns and allows for a collaborative approach to address both issues [52:1]. Healthcare providers should be aware of the impact of social injustice on their patients' health and well-being and seek to address these issues in a sensitive and supportive manner [52:3]. In Mr. Johnson's case, his concerns about social injustices in his community may be contributing to his symptoms [52:2], and addressing only his medical concerns would not address the root cause of his distress. The other options do not address the potential impact of social injustice on his health, do not adequately address the patient's concerns, and although community activism may be helpful, healthcare providers should be careful not to impose their own values or beliefs on their patients [52:10, 52:12].
**
52. Reflection Vignettes
1. Dr. Jasmine Kim, a 35-year-old physician, meets with a new patient, Mr. Abdulrahman Al-Faisal, a 45-year-old male of Middle Eastern descent. Dr. Kim and Mr. Al-Faisal have different phenotypes and cultural identities. Dr. Kim takes note of this and recognizes the importance of providing culturally sensitive care to Mr. Al-Faisal. She is aware that structural injustice can affect healthcare disparities and that patients from different ethnic backgrounds may face barriers to accessing healthcare. Dr. Kim strives to establish a patient-practitioner relationship based on mutual trust and respect, and to provide Mr. Al-Faisal with the information he needs to make informed decisions about his healthcare. The differential diagnosis includes cultural barriers to healthcare access and cultural differences in health beliefs and practices.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
2. Ms. Emily Jackson, a 32-year-old journalist, presents to the practitioner for a general check-up. She reports feeling healthy and having no specific medical concerns. During the consultation, Ms. Jackson expresses her passion for sports and politics and attempts to engage the practitioner in a discussion about current events. The practitioner acknowledges Ms. Jackson's interests but redirects the conversation back to her health and medical history. The differential diagnosis includes no medical concerns, and the practitioner emphasizes the importance of focusing on Ms. Jackson's health during the visit.
The practitioner avoids engaging in a discussion about sports and politics with the patient because it can potentially create a power imbalance and distract from the primary purpose of the visit, which is to conduct a general check-up. Additionally, the practitioner may not have expertise in sports or politics and may feel uncomfortable discussing these topics. By focusing on the patient's health and well-being, the practitioner can maintain a professional and objective approach to the visit and provide the best possible care to the patient.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
