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      Relational care and epistemic injustice

      research-article
      1 , 2 , 3 ,
      Primary Health Care Research & Development
      Cambridge University Press
      autonomy, epistemic injustice, primary care

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          Abstract

          The philosophical underpinnings of primary care have been examined from several perspectives in recent years. In two previous articles, we have argued that a relational view of autonomy is better matched to the primary care setting than others, and that view is mainly formed from the descriptors of its practice. Here we develop that analysis further, linking it to other relevant theory: the experience of human suffering and epistemic injustice. We argue that relational care is fundamental to ameliorating epistemic injustice and that relationships are integral to ethical practice, rather than being distinct. We propose that personalised care as described in the NHS Long Term Plan is not possible without addressing epistemic injustice and therefore without reconsidering our existing normative ethical frameworks.

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          Most cited references18

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          Syndemics and the biosocial conception of health.

          The syndemics model of health focuses on the biosocial complex, which consists of interacting, co-present, or sequential diseases and the social and environmental factors that promote and enhance the negative effects of disease interaction. This emergent approach to health conception and clinical practice reconfigures conventional historical understanding of diseases as distinct entities in nature, separate from other diseases and independent of the social contexts in which they are found. Rather, all of these factors tend to interact synergistically in various and consequential ways, having a substantial impact on the health of individuals and whole populations. Specifically, a syndemics approach examines why certain diseases cluster (ie, multiple diseases affecting individuals and groups); the pathways through which they interact biologically in individuals and within populations, and thereby multiply their overall disease burden, and the ways in which social environments, especially conditions of social inequality and injustice, contribute to disease clustering and interaction as well as to vulnerability. In this Series, the contributions of the syndemics approach for understanding both interacting chronic diseases in social context, and the implications of a syndemics orientation to the issue of health rights, are examined.
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            Person-centered care--ready for prime time.

            Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness. Copyright © 2011 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.
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              Capability and Well‐Being

                Author and article information

                Journal
                Prim Health Care Res Dev
                Prim Health Care Res Dev
                PHC
                Primary Health Care Research & Development
                Cambridge University Press (Cambridge, UK )
                1463-4236
                1477-1128
                2023
                23 October 2023
                : 24
                : e62
                Affiliations
                [ 1 ] Health Education England , London, UK
                [ 2 ] Anglia Ruskin University , Cambridge, UK
                [ 3 ]Institute of Medical and Biomedical Education, St George’s University of London , London, UK
                Author notes
                Corresponding author: John Spicer; Email: johnspicer@ 123456doctors.org.uk
                Author information
                https://orcid.org/0000-0001-9079-0971
                https://orcid.org/0000-0002-5830-0853
                https://orcid.org/0000-0002-1700-4038
                Article
                S1463423623000555
                10.1017/S1463423623000555
                10594641
                37870126
                6354e804-5934-4aa4-90b0-ebf59e180887
                © The Author(s) 2023

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

                History
                : 10 January 2023
                : 18 April 2023
                : 07 August 2023
                Page count
                References: 20, Pages: 4
                Categories
                Development

                autonomy,epistemic injustice,primary care
                autonomy, epistemic injustice, primary care

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