Engaged Doctoring: Adapting Medicine to Extreme Poverty

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 17. Healthcare Providers & Practice I

Abstract

How is medical care delivered when patients live in extreme poverty? While health policy and medical education increasingly call on clinicians to address the social determinants of health and provide low-barrier care, we know little about how these mandates unfold in everyday practice. Drawing on two years of ethnographic research with street medicine teams—including participant observation of more than 350 clinician–patient encounters, 50 interviews with clinicians and unhoused patients, and analysis of policy and training documents—this paper examines how providers engage and treat patients whose intertwined medical and social risks both worsen illness and obstruct access to care. I develop the concept of engaged doctoring to describe a form of medical practice in which clinicians actively pursue, relationally sustain, and socially adapt care. Engaged doctoring rests on three forms of labor. First, clinicians produce access through intensive outreach, trust-building activities, and emotional labor. Second, they adapt clinical decisions to social risks—such as policing, displacement, and housing insecurity—modifying treatments to make them feasible in precarious conditions. Third, they extend care into social treatment, acting as advocates and brokers within fragmented service systems and making discretionary, often gendered judgments about who faces the most imminent risk and therefore merits scarce resources. Although this model expands access, it shifts the burdens of structural inequality onto providers and embeds moral triage within everyday care. By showing how medicine is reorganized outside clinic walls to serve people in extreme poverty, this study advances sociological understandings of medical training, inequality, and the limits of social medicine.

Author

• Irene Del Mastro Naccarato, University of California-Los Angeles