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The problem is suggestion that better training & education for medical learners is a powerful antistigma intervention.
This is wrong on at least two grounds. First, stigma is structural, which means true antistigma work has to be directed upstream.
https://www.tandfonline.com/eprint/DN87ESMVGGYNDCBSD5EZ/full?target=10.1080/08897077.2020.1843104
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This is wrong on at least two grounds. First, stigma is structural, which means true antistigma work has to be directed upstream.
https://www.tandfonline.com/eprint/DN87ESMVGGYNDCBSD5EZ/full?target=10.1080/08897077.2020.1843104
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If you've followed me for any length of time on here, you know how much I go on about this exact pt. It's good to have better education and training -- let's do that!
It even has some antistigma impact, but the effects are relatively modest and transient.
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It even has some antistigma impact, but the effects are relatively modest and transient.
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We've got to dislodge ourselves from the idea that robust antistigma work can be accomplished via methodologically individualist interventions -- changing attitudes, practices, and beliefs at individual level.
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(This is where a considerable portion of my work in #legalepi & #phlaw is focused right now -- using law and policy interventions to address stigma upstream, closer to roots of structural violences.
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But the idea of using education to resolve stigma power in #meded also can extend hoary and generally weak theories of learning and education itself -- namely, the very weak effects of the formal curriculum on behavior.
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Fred Hafferty's work, among many others, in the mid-90s, prompted a conceptual overhaul in #meded b/c it showed that the hidden and informal curricula have a much larger effect in shaping attitudes, practices, and beliefs.
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Giving medical learners facts about diseases, drugs, and the people they treat turns out to be a mostly ineffective way of addressing stigmatizing or shaming attitudes, practices, and beliefs. In my own work on pain, I kept returning to this quote from C. Stratton Hill.
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Hill was a retired oncologist in Houston and one of the early leaders in the efforts to improve pain mgmt in the 1990s. I was fortunate to visit with him on many occasions as I wrote my diss on chronic pain -- should have taken oral histories, dammit.
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But in an important JAMA letter in 1995, he wrote that "attitudes about pain are systematically transferred from one generation to the next." In my work on the history of pain, I've tried to show exactly how this happens, from 19th c. dynamics to the present.
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But giving learners facts about chronic pain just is not going to do much to address the devastating and inequitable impact of pain stigma. Nor will it do much for SUD, addiction, or opioid stigmas.
We have to think bigger. We have to think structurally.
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We have to think bigger. We have to think structurally.
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We have to internalize that health equity work starts with history, as does antistigma work. We need to engage w/ and teach about the ways that historical patterns of domination, oppression, and subordination ground stigma against PWUDs and PWA.
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Teaching medical learners facts about naloxone is fine. But that's not much of an antistigma intervention.
Structural violence is the conceptual framework w/ which we should start IMO.
#stigma #stigmastudies #phlaw #phethx #legalepi #scholarteacher #historymatters
12/12
Structural violence is the conceptual framework w/ which we should start IMO.
#stigma #stigmastudies #phlaw #phethx #legalepi #scholarteacher #historymatters
12/12
