Social factors in clinical complexity: reflections from a paediatric unit

Abstract

Medical text books have taught us evaluation and diagnosis of disease based on patients' symptoms, signs and relevant investigations and treatment is then implemented according to the clinical condition and current best available evidence. There are objective scoring scales to assess the severity of the condition, progress and eventual outcome. These scales rarely if ever consider the impact of social factors on the course of treatment and eventual clinical outcome. But in a country like India with diverse cultural backgrounds and deep social structures social, cultural and economic factors have great ramifications on the clinical course, treatment and ultimate outcome. Diverse beliefs, faiths, social norms and cultural practices not only have a direct effect on a person's daily life but indirectly also effect educational, professional and health care access. The effects of these factors on families and their way of deciding on their child's management in complex systems show multifaceted dynamic interactions leading to at times unexpected outcomes.