http://orcid.org/0000-0003-2825-0354
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Abstract
Intersectionality has become a significant intellectual approach for those thinking about the ways that race, gender, and other social identities converge in order to create unique forms of oppression. Although the initial work on intersectionality addressed the unique position of black women relative to both black men and white women, the concept has since been expanded to address a range of social identities. Here we consider how to apply some of the theoretical tools provided by intersectionality to the clinical context. We begin with a brief discussion of intersectionality and how it might be useful in a clinical context. We then discuss two clinical scenarios that highlight how we think considering intersectionality could lead to more successful patient–clinician interactions. Finally, we extrapolate general strategies for applying intersectionality to the clinical context before considering objections and replies.
Notes
1. Crenshaw herself acknowledges this in the opening lines of her article when she highlights the 1982 volume edited by Gloria T. Hull et al., All the Women Are White, All the Blacks Are Men, But Some of Us Are Brave.
2. We take this view because individuals’ lives are rarely simply characterized and exclusively marginalized. As individual mature and age, and as their circumstances change, they may vary in the way and the degree to which they are marginalized.
3. Since the initial review of this article, there has been increased media attention given to the dramatic disparities in black women’s maternal health outcomes, including the story of the life-threatening postpartum crisis of tennis star Serena Williams. See, e.g., Haskell (Citation2018), Martin and Montagne (Citation2017), Jamison (Citation2018), Cullors (Citation2018), and Villarosa (Citation2018).
4. Given that intersectionality is fundamentally a tool to resist oppression, one might argue that to lament middle-class African Americans’ inability to leverage their class privilege, as opposed to criticizing class privilege altogether, is misguided. Our response to this worry is that while the normative aim of intersectionality is to resist oppression, to the extent that we have social classes, intersectionality allows us to make descriptive claims about how class is confounded by other axes of identity, like race or disability status.
5. We grant that if one is doing research with a large data set, one might be advised to add class and other factors to the analysis in order to understand the data fully.
6. Centering Pregnancy is a well-established model of group prenatal care. Providing care in this way allows the patients and providers to relax and get to know one another on a deeper and more meaningful level. Members of the group form lasting friendships and are connected in ways not possible in traditional care. The program brings women who may have differing backgrounds and experiences together to share the common experience of pregnancy. See details about the Centering Pregnancy Institute available at: https://www.centeringhealthcare.org/what-we-do/centering-pregnancy
7. One may wonder why we have decided to include a case involving a male patient in an article where we advocate using the tools of intersectionality, an explicitly feminist theory, in the clinical environment. As we discuss earlier in the article, there is disagreement within the intersectionality literature regarding how to conceptualize intersectional identity. (Recall, for example, Nash [Citation2008, 10].) We think that intersectionality offers the appropriate vocabulary to discuss how axes of identity shape and are shaped by the social structures that one navigates. Mr. Fuentes is a male patient, not because we have chosen to center maleness (which would defeat the fundamental project of intersectionality), but in order to show the connection between his multiple marginalization (along the axes of ethnicity and class) and the structural barriers to a successful clinical encounter. Bowleg observes that although women “remain the focus of the vast majority of intersectionality scholarship,” the assumed social and economic privileges that men are presumed to have “evaporate” for African American men when their race and SES intersect (Bowleg Citation2012, 755). We think one can make a similar claim about Latinos. Meanwhile, Griffith understands intersectionality as providing “a systematic way” to think about the role of sex and gender in men’s health (Griffith Citation2012, Citation2016).
8. The increased scrutiny is the result of the stereotype that African Americans and Latinos are more likely to be drug abusers/seekers.
9. Dr. Roberts need not hold any explicit racial/ethnic animus toward Mr. Fuentes. However, implicit bias research (based on Implicit Association Test, or IAT, results) shows that clinicians hold bias against Latinos compared to whites. These biases (explicit or implicit) are often stereotype consistent, for example, “Latinos are drug abusers.” The facts that Mr. Fuentes has (a) sought help at a walk-in clinic instead of through a primary care physician and (b) explicitly asks for “stronger” medications were probably already red flags for Dr. Roberts. In this instance Mr. Fuentes’s Latino identity was the (possibly unconscious) tipping point for Dr. Roberts that resulted in issuing a referral for physical therapy, rather than a prescription for opioids. Similarly, an interesting study with African American subjects showed that even when African Americans have access to regular physicians who are aware of their patients’ chronic pain, African American patients were still more likely than white patients to be subjected to opioid abuse risk reduction strategies such as urine drug tests, more frequently scheduled office visits, and restricted early refills. See Becker and colleagues (Citation2011).
10. Another clear example is epidemiologic data demonstrating the differential effects of rural life on individuals of different ethnic backgrounds (James et al. Citation2017).
11. Wilson, Danis, and White have written elsewhere in response to concerns raised by Grzanka and colleagues that how one experiences of racism (for example) will vary by gender, sexual orientation, and educational attainment. However, sometimes it may be important to delineate the experience of racism from other forms of discrimination (Wilson, Danis, and White Citation2016, W2).