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The clinical encounter as local moral world: Shifts of assumptions and transformation in relational context

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  • Katz, Arlene M.
  • Alegría, Margarita

Abstract

In this study we consider the process of the clinical encounter, and present exemplars of how assumptions of both clinicians and their patients can shift or transform in the course of a diagnostic interview. We examine the process as it is recalled, and further elaborated, in post-diagnostic interviews as part of a collaborative inquiry during reflections with clinicians and patients in the northeastern United States. Rather than treating assumptions by patients and providers as a fixed attribute of an individual, we treat them as occurring between people within a particular social context, the diagnostic interview. We explore the diagnostic interview as a landscape in which assumptions occur (and can shift), navigate the features of this landscape, and suggest that our examination can best be achieved by the systematic comparison of views of the multiple actors in an experience-near manner. We describe what might be gained by this shift in assumptions and how it can make visible what is at stake for clinician and patient in their local moral worlds--for patients, acknowledgment of social suffering, for clinicians how assumptions are a barrier to engagement with minority patients. It is crucial for clinicians to develop this capacity for reflection when navigating the interactions with patients from different cultures, to recognize and transform assumptions, to notice 'surprises', and to elicit what really matters to patients in their care.

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  • Katz, Arlene M. & Alegría, Margarita, 2009. "The clinical encounter as local moral world: Shifts of assumptions and transformation in relational context," Social Science & Medicine, Elsevier, vol. 68(7), pages 1238-1246, April.
    • Handle: RePEc:eee:socmed:v:68:y:2009:i:7:p:1238-1246
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    1. Katz, Arlene M. & Shotter, John, 1996. "Hearing the patient's 'voice': Toward a social poetics in diagnostic interviews," Social Science & Medicine, Elsevier, vol. 43(6), pages 919-931, September.
    2. Balsa, Ana I. & McGuire, Thomas G., 2003. "Prejudice, clinical uncertainty and stereotyping as sources of health disparities," Journal of Health Economics, Elsevier, vol. 22(1), pages 89-116, January.
    3. van Ryn, Michelle & Burke, Jane, 2000. "The effect of patient race and socio-economic status on physicians' perceptions of patients," Social Science & Medicine, Elsevier, vol. 50(6), pages 813-828, March.
    4. Radley, Alan & Chamberlain, Kerry, 2001. "Health psychology and the study of the case: from method to analytic concern," Social Science & Medicine, Elsevier, vol. 53(3), pages 321-332, August.
    5. Yang, Lawrence Hsin & Kleinman, Arthur & Link, Bruce G. & Phelan, Jo C. & Lee, Sing & Good, Byron, 2007. "Culture and stigma: Adding moral experience to stigma theory," Social Science & Medicine, Elsevier, vol. 64(7), pages 1524-1535, April.
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    4. Stevens, Lindsay M., 2015. "Planning parenthood: Health care providers' perspectives on pregnancy intention, readiness, and family planning," Social Science & Medicine, Elsevier, vol. 139(C), pages 44-52.

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