This literature review examines how providers are positioned within the US healthcare system as medical gatekeepers, rather than universal deliverers of care. In essence, this indicates that healthcare professionals are tasked with constructing deservingness of care, in addition to their other basic clinical responsibilities. My research aims to explore and identify the mechanisms by which patient “deservingness” is socially constructed. First, this project illustrates how providers construct and enforce their deservingness constructions through micro level interactions with their patients in clinical settings. Secondly, this review highlights macro level societal and cultural phenomena that shape providers’ deservingness constructions, as well as how these phenomena govern patient-provider interactions. While there are numerous populations that have systematically been constructed to be less deserving of compassionate and comprehensive care in our society, this project narrows in on how people who use drugs (PWUDs) are often perceived to be undeserving of the same quality of care as abstinent and sober patients. The findings of this literature review are incredibly relevant to the current state of healthcare in the United States and much of the Western world. Especially during a global pandemic that has placed significant strain on resources, health organizations, and individual providers, interrogating how we understand and construct patient deservingness is imperative for creating a more equitable healthcare system that can adequately optimize the health of the whole population.

Maria would like to thank her faculty sponsor Dr. Elizabeth Chiarello for their support of this project.