We wish to recognize a publication this week in the New England Journal of Medicine co-authored by two physicians from the Maine-Dartmouth Family Medicine Residency. Cheryl Seymour MD, faculty at the residency, and Carrie Griffin DO, a 2015 residency alum, have written a case analysis entitled: “Structural Differential – A 32 Year Old Man with Persistent Wrist Pain” which is attached below. An associated podcast can be downloaded from the journal page.
This case is the second in a new monthly series in the New England Journal of Medicine entitled, “Case Studies in Social Medicine.” Each article is written by clinicians and social scientists, using a clinical case to illustrate a social science concept that helps readers understand the ways in which the social world powerfully impacts health, disease, and health care.
There is increasing recognition that the social world – from growing economic inequity to structural racism, mass incarceration and anti-immigrant prejudice – critically impacts health and health care at all levels, including our individual encounters with patients. Many of the interventions, health systems, and health care practices to date have been ineffective in addressing these structural causes of illness and health inequity, leading to a call for increased skill in recognizing and responding to the social world. This case series is one method of beginning to address the need among health professionals for a shared vocabulary and understanding of how the social world directly impacts patients, clinicians and health systems.
This particular case is drawn from Dr. Griffin and Seymour’s experience caring for Maine’s blueberry rakers as part of the Maine Mobile Health Program. Using the common complaint of raker’s tendonitis as an example, they introduce the concept of a structural differential – a practice that all providers can use, especially in challenging clinical situations, to consider the social, political, and economic factors that may be influencing a patient’s health and to facilitate responses to modifiable factors.