SOCIOECONOMIC BURDENS IN STROKE CARE AND MEASURES TO INCREASE AGENCY IN A REALM OF LIMITED AUTONOMY

Abstract

In hospitals situated in the center of underserved communities, such as North Philadelphia, health care workers are often faced with challenges to patient health that stem from their socioeconomic status. This is an obvious problem in stroke prevention, which requires patients to eat healthy, maintain adherence to medications, and exercise, among other things. As social determinants of health limit a patient’s ability to act on these recommendations, health care workers are forced to grapple with the question of how to best care for a patient with limited resources. Though some may label this patient as difficult due to what may be viewed superficially as non-adherence to medications and lack of motivation to change their lifestyle’, a more compassionate and accurate observation is one that acknowledges the fact that these patients are unable to act on any recommendations given to them due to limitations on their autonomy by several social barriers, such as lack of access to follow-up, transportation, income, food, etc. As physicians have a duty to respect a patient’s autonomy, what this also requires is ensuring a patient understands how best to navigate within their limited autonomy, i.e. how to exercise their agency. Instead of waiting for policymakers to incite change, at the micro level, health care workers can take additional measures by providing resources within their limitations that will then improve a patient’s agency and, as a result, improve their health.