‘It's not just to treat everybody the same’: A social justice framework for caring for larger patients in healthcare practice

Abstract

Drawing on semi-structured interviews with larger bodied patients (n = 20) and their healthcare practitioners (n = 22) in Canada, this paper combines micro and macro approaches in outlining a social justice approach to caring for larger patients in healthcare practice.Theoretically, we draw upon structural competency and critical consciousness to address the question of how social justice is enacted, experienced, and understood in interactions between clinicians and larger patients.Our findings highlight four key themes that provide a framework for integrating social justice into healthcare practice: (1) an awareness of one's simultaneous experience of marginalisation and privilege in the clinical interaction; (2) navigating between additive and interactive understandings of intersectionality; (3) micro and macro approaches to change; and (4) straddling the line between equity and equality. The synergies in participants' perspectives across social identities suggests that the cultivation of social justice awareness potentially mitigates some blinders of privilege. Furthermore, practitioners' social justice orientation positively impacted patient experience, with most patients expressing appreciation for having their various histories of trauma

Diagnosing social ills: Theorising social determinants of health as a diagnostic category

“…However, legitimacy is also granted to practitioners— and the field of medicine, more broadly—such as in having social determinants recognised as integral to care. This is not to suggest that non‐clinical information goes unacknowledged (Buchbinder, 2017; Gutin, 2022; Lane, 2020; Pickersgill, 2020), or that clinicians never deviate from diagnostic protocol in response to nonclinical information (Kanagasingam et al., 2022; Whooley, 2010). Yet, individual practitioners’ propensities to recognise social determinants as important is fundamentally distinct from their having institutional recognition that legitimises these beliefs and facilitates actionable steps.…”