“You are the only other person in the world that knows that about me”: Family physician stories of proximity to patients experiencing social inequity
Canadians' health outcomes are inextricably tied to social inequities. Family medicine is uniquely situated to provide care that addresses social factors through longitudinal knowledge of patients and the contexts of their lives. However, family physicians have come under increased practice dem...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-06-01
|
| Series: | SSM: Qualitative Research in Health |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667321523001622 |
| _version_ | 1797390354496880640 |
|---|---|
| author | Monica L. Molinaro Katrina Shen Chitrini Tandon Gina Agarwal Gabrielle Inglis Meredith Vanstone |
| author_facet | Monica L. Molinaro Katrina Shen Chitrini Tandon Gina Agarwal Gabrielle Inglis Meredith Vanstone |
| author_sort | Monica L. Molinaro |
| collection | DOAJ |
| description | Canadians' health outcomes are inextricably tied to social inequities. Family medicine is uniquely situated to provide care that addresses social factors through longitudinal knowledge of patients and the contexts of their lives. However, family physicians have come under increased practice demands shaped by neoliberal ideological structuring of health care, compounding difficulties in providing care for persons experiencing health needs related to social inequities. Nursing scholar Ruth Malone has argued that remaining proximal, or close to patients, is a form of resistance to these demands. Using a critical narrative methodology, this paper presents the stories of 20 family physicians working with persons experiencing health needs related to inequity in Ontario, Canada, that express and expand upon Malone's proximity. We highlight how participants invoke notions of proximity through their stories, describing the role of the family physician in: i) generating physical proximity based on the patients' needs for more time, space, and care; ii) developing narrative proximity through storytelling over time in these shared spaces, both between colleagues and patient communities; and iii) engaging in moral proximity, or recognizing the vulnerabilities of their patients, by going “above and beyond” in their care and advocacy roles inspired by the needs of their patients. The findings add theoretical depth to proximity, extending this conceptualization into a new clinical context. These stories also complement current health services and health policy research that advocates for collaborative primary care approaches, as elements of these approaches are conducive to establishing proximity with patients who need care the most. |
| first_indexed | 2024-03-08T23:09:34Z |
| format | Article |
| id | doaj.art-862bb0213a734051883f11ca1c1d0e12 |
| institution | Directory Open Access Journal |
| issn | 2667-3215 |
| language | English |
| last_indexed | 2024-03-08T23:09:34Z |
| publishDate | 2024-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | SSM: Qualitative Research in Health |
| spelling | doaj.art-862bb0213a734051883f11ca1c1d0e122023-12-15T07:27:08ZengElsevierSSM: Qualitative Research in Health2667-32152024-06-015100378“You are the only other person in the world that knows that about me”: Family physician stories of proximity to patients experiencing social inequityMonica L. Molinaro0Katrina Shen1Chitrini Tandon2Gina Agarwal3Gabrielle Inglis4Meredith Vanstone5Institute of Health Sciences Education, McGill University, Lady Meredith House, 1110 Pine Ave W, Montreal, QC, H3A 1A3, Canada; Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada; Corresponding author. Institute of Health Sciences Education, McGill University, Lady Meredith House, 1110 Pine Ave W, Montreal, QC, H3A 1A3, Canada.Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, ON, L8P 1H6, CanadaDepartment of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, ON, L8P 1H6, CanadaDepartment of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, ON, L8P 1H6, CanadaDepartment of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, ON, L8P 1H6, CanadaDepartment of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, ON, L8P 1H6, CanadaCanadians' health outcomes are inextricably tied to social inequities. Family medicine is uniquely situated to provide care that addresses social factors through longitudinal knowledge of patients and the contexts of their lives. However, family physicians have come under increased practice demands shaped by neoliberal ideological structuring of health care, compounding difficulties in providing care for persons experiencing health needs related to social inequities. Nursing scholar Ruth Malone has argued that remaining proximal, or close to patients, is a form of resistance to these demands. Using a critical narrative methodology, this paper presents the stories of 20 family physicians working with persons experiencing health needs related to inequity in Ontario, Canada, that express and expand upon Malone's proximity. We highlight how participants invoke notions of proximity through their stories, describing the role of the family physician in: i) generating physical proximity based on the patients' needs for more time, space, and care; ii) developing narrative proximity through storytelling over time in these shared spaces, both between colleagues and patient communities; and iii) engaging in moral proximity, or recognizing the vulnerabilities of their patients, by going “above and beyond” in their care and advocacy roles inspired by the needs of their patients. The findings add theoretical depth to proximity, extending this conceptualization into a new clinical context. These stories also complement current health services and health policy research that advocates for collaborative primary care approaches, as elements of these approaches are conducive to establishing proximity with patients who need care the most.http://www.sciencedirect.com/science/article/pii/S2667321523001622Family medicineInequityProximityHealth policySocial policyRemuneration |
| spellingShingle | Monica L. Molinaro Katrina Shen Chitrini Tandon Gina Agarwal Gabrielle Inglis Meredith Vanstone “You are the only other person in the world that knows that about me”: Family physician stories of proximity to patients experiencing social inequity SSM: Qualitative Research in Health Family medicine Inequity Proximity Health policy Social policy Remuneration |
| title | “You are the only other person in the world that knows that about me”: Family physician stories of proximity to patients experiencing social inequity |
| title_full | “You are the only other person in the world that knows that about me”: Family physician stories of proximity to patients experiencing social inequity |
| title_fullStr | “You are the only other person in the world that knows that about me”: Family physician stories of proximity to patients experiencing social inequity |
| title_full_unstemmed | “You are the only other person in the world that knows that about me”: Family physician stories of proximity to patients experiencing social inequity |
| title_short | “You are the only other person in the world that knows that about me”: Family physician stories of proximity to patients experiencing social inequity |
| title_sort | you are the only other person in the world that knows that about me family physician stories of proximity to patients experiencing social inequity |
| topic | Family medicine Inequity Proximity Health policy Social policy Remuneration |
| url | http://www.sciencedirect.com/science/article/pii/S2667321523001622 |
| work_keys_str_mv | AT monicalmolinaro youaretheonlyotherpersonintheworldthatknowsthataboutmefamilyphysicianstoriesofproximitytopatientsexperiencingsocialinequity AT katrinashen youaretheonlyotherpersonintheworldthatknowsthataboutmefamilyphysicianstoriesofproximitytopatientsexperiencingsocialinequity AT chitrinitandon youaretheonlyotherpersonintheworldthatknowsthataboutmefamilyphysicianstoriesofproximitytopatientsexperiencingsocialinequity AT ginaagarwal youaretheonlyotherpersonintheworldthatknowsthataboutmefamilyphysicianstoriesofproximitytopatientsexperiencingsocialinequity AT gabrielleinglis youaretheonlyotherpersonintheworldthatknowsthataboutmefamilyphysicianstoriesofproximitytopatientsexperiencingsocialinequity AT meredithvanstone youaretheonlyotherpersonintheworldthatknowsthataboutmefamilyphysicianstoriesofproximitytopatientsexperiencingsocialinequity |