Case Studies in Social Medicine — Attending to Structural Forces in Clinical Practice

Stonington, Scott; Holmes, Seth M.; Hansen, Helena; Greene, Jeremy A.; Wailoo, Keith; Malina, Debra; Morrissey, Stephen; Farmer, Paul; Marmot, Michael

doi:10.1056/nejmms1814262

Cited by 65 publications

(34 citation statements)

References 22 publications

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“…The need to re-imagine and re-make global health Inequity is a driving force in this pandemic, both in how specific countries and regions will fare as well as how specific communities are made more vulnerable by social structures (Stonington et al, 2018) within countries. We cannot hope to address these asymmetries when our global health institutions mirror and even reproduce the inequities in the larger world.…”

Section: Power Differentials Globally Regionally and Locallymentioning

confidence: 99%

COVID-19 reveals weak health systems by design: Why we must re-make global health in this historic moment

Shamasunder

Holmes

Goronga

et al. 2020

Global Public Health

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125

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The COVID-19 pandemic demonstrates the critical need to reimagine and repair the broken systems of global health. Specifically, the pandemic demonstrates the hollowness of the global health rhetoric of equity, the weaknesses of a health security-driven global health agenda, and the negative health impacts of power differentials not only globally, but also regionally and locally. This article analyses the effects of these inequities and calls on governments, multilateral agencies, universities, and NGOs to engage in true collaboration and partnership in this historic moment. Before this pandemic spreads furtherincluding in the Global Southwith potentially extreme impact, we must work together to rectify the field and practice of global health. ARTICLE HISTORY

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Section: Power Differentials Globally Regionally and Locallymentioning

confidence: 99%

COVID-19 reveals weak health systems by design: Why we must re-make global health in this historic moment

Shamasunder

Holmes

Goronga

et al. 2020

Global Public Health

Self Cite

125

View full text Add to dashboard Cite

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“…My interlocutors would readily acknowledge that brain waves are not ugly because of any fault inherent to the patient or their brain. Brain waves are ugly because they are neither normal nor legible to the diagnostic technologies and classificatory norms of present-day biomedicine in ways that are consistent with the structural and temporal pressures faced by doctors: long working hours, heavy caseloads, the mundanity of EEG interpretation, and the imperative to act quickly (Bowker and Star, 1999; Montgomery, 2006; Stonington et al., 2018). Further, EEGs are not objectified and detached “data” but in fact the result of a relational, durational, and contingent process that is inextricably tied to the patient and their environment (Marathe, 2019).…”

Section: Discussion: Towards Disability-informed Seizure Diagnosismentioning

confidence: 99%

Seizure aesthetics: Temporal regimes and medical technology in epilepsy diagnosis

Marathe

2020

Time & Society

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Epilepsy is a neurological condition defined by time; it is characterized by a lifelong tendency for recurrent, unpredictable, and unprovoked seizures, during which people lose control over parts of body-mind function. Diagnosing seizures involves using electroencephalograms to represent and classify brain waves in relation to clock time. Drawing upon ethnographic fieldwork in a North American teaching hospital, this paper shows that as neurologists learn to diagnose seizures, they internalize clock time norms for normal and abnormal brain waves. The paper demonstrates how these temporal norms work to assign a set of aesthetics to brain waves: patterns that conform to clock-time norms are beautiful, whereas hard-to-classify patterns are ugly. These aesthetic judgments follow diagnostically complex patients in future hospital visits, who become known, for instance, as “the patient with the ugly EEG.” The paper critiques this ascription of labels to patients and situates the role of the electroencephalogram's clock time in this predicament. It concludes with a speculative design project that reorients the relationship between temporality and embodiment by using the heartbeat as a situated and co-produced alternative to the standardized and invariant clock. Ultimately, the paper argues that the aesthetics of medical technology are fundamental to clinical care, thereby opening up new directions for research at the intersection of critical time studies and disability studies.

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“…The idea is pretty much everywhere in American medicine at this point, and a couple of years ago the august New England Journal of Medicine started a series called “Case Studies in Social Medicine” to move the ball even further and focus on societal‐level structural factors that have an impact on health outcomes 4 . I've read these case studies with interest, and I've found that a lot of what they have to say fits with what I learned, formally and informally, as a psychiatry resident captivated by George Engel's then‐new formulation of the “biopsychosocial model.” And they certainly fit with what I've learned as a practicing physician and psychiatrist over the past several decades.…”

Section: Social Determinantsmentioning

confidence: 99%

The 2020 election commentary

Price¹

2020

Psychopharmacology Update

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Case Studies in Social Medicine — Attending to Structural Forces in Clinical Practice

Cited by 65 publications

References 22 publications

COVID-19 reveals weak health systems by design: Why we must re-make global health in this historic moment

COVID-19 reveals weak health systems by design: Why we must re-make global health in this historic moment

Seizure aesthetics: Temporal regimes and medical technology in epilepsy diagnosis

The 2020 election commentary

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