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Insights from the shadows: exploring deservingness of care in the emergency department and language as a social determinant of health
  1. Seiichi Villalona1,2
  1. 1 Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
  2. 2 Anthropology, University of South Florida College of Arts and Sciences, Tampa, Florida, USA
  1. Correspondence to Mr Seiichi Villalona, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ 08901, USA; svillalona{at}


This study addresses the existing gap in literature that ethnographically examines the experiences of Spanish-speaking patients with limited English proficiency in clinical spaces. All of the participants in this study presented to the emergency department (ED) for evaluation of non-urgent health conditions. Patient shadowing was employed to explore the challenges that this population face in unique clinical settings like the ED. This relatively new methodology facilitates obtaining nuanced understandings of clinical contexts under study in ways that quantitative approaches and survey research do not. Drawing from the field of medical anthropology and approach of narrative medicine, the collected data are presented through the use of clinical ethnographic vignettes and thick description. The conceptual framework of health-related deservingness guided the analysis undertaken in this study. Structural stigma was used as a complementary framework in analysing the emergent themes in the data collected. The results and analysis from this study were used to develop an argument for the consideration of language as a distinct social determinant of health.

  • emergency medicine
  • medical anthropology
  • medical humanities

Data availability statement

Data sharing not applicable as no datasets were generated and/or analysed for this study.

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Data availability statement

Data sharing not applicable as no datasets were generated and/or analysed for this study.

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  • Contributors SV is the sole contributor of the analysis undertaken in this article.

  • Funding This project was partially supported by the USF Health Division of Emergency Medicine Research TEAMHealth Scholars Program.

  • Competing interests None declared.

  • Patient and public involvement This statement was included throughout the Methodology section in discussing the main approach of patient shadowing: 'The use of patient shadowing facilitated the researcher–participant relationship when considering that both parties were closely involved in the generation of the qualitative data being collected, as well as the interpretation of the contexts under study. While the researcher has general areas of interest to explore, consenting participants predominantly guided the data collected through their own open-ended discussions of their experiences in real time. This allowed for the prioritisation of the patient’s experience in articulating their perspectives' (pp 8,9). A follow-up to this was added in discussing the data collection approach: 'This approach to data collection was iterative through continual clarification on the statements and experiences shared, in order to prioritise the perspectives of the study participants' (p 10).

  • Provenance and peer review Not commissioned; internally peer reviewed.