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Narrative Intersectionality in Caring for Marginalized or Disadvantaged Patients

Thinking Beyond Categories in Medical Education and Care

Blackie, Michael, PhD; Wear, Delese, PhD; Zarconi, Joseph, MD

doi: 10.1097/ACM.0000000000002425
Articles

Categories are essential to doctors’ thinking and reasoning about their patients. Much of the clinical categorization learned in medical school serves useful purposes, but an extensive literature exists on students’ reliance on broad systems of social categorization. In this article, the authors challenge some of the orthodoxies of categorization by combining narrative approaches to medical practice with the theoretical term “intersectionality” to draw students’ attention to the important intersecting, but often overlooked, identities of their patients. Although intersectionality applies for all patients, the focus here is on its importance in understanding and caring for marginalized or disadvantaged persons.

Intersectionality posits that understanding individual lives requires looking beyond categories of identity in isolation and instead considering them at their intersection, where interrelated systems of power and oppression, advantage and discrimination are at play and determine access to social and material necessities of life. Combined with narrative approaches that emphasize the singularity of a person’s story, narrative intersectionality can enable a more robust understanding of how injustice and inequality interrelate multidimensionally to produce social disadvantage.

The authors apply this framework to two films that present characters whose lives are made up of numerous and often-contradictory identities to highlight what physicians may be overlooking in the care of patients. If the education of physicians encourages synthesis and categorization aimed at the critically useful process of making clinical “assessments” and “plans,” then there must also be emphasis in their education on what might be missing from that process.

M. Blackie is associate professor of health humanities, Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, Illinois.

D. Wear is professor of family and community medicine, Northeast Ohio Medical University, Rootstown, Ohio.

J. Zarconi is professor and chair of internal medicine and senior associate dean for health affairs, Northeast Ohio Medical University, Rootstown, Ohio.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Michael Blackie, Department of Medical Education, University of Illinois at Chicago, 808 S. Wood St., CME 986, Chicago, IL 60612; e-mail: blackie@uic.edu.

© 2019 by the Association of American Medical Colleges