Vulnerability is a concept associated with the effects of social inequities to access health care services. On a hospital level, vulnerable populations must be identified and favored over others. The aims of this study were the analysis of the conceptions and practices of social workers regarding vulnerable patients, and the identification of theoretical elements of vulnerability given by academics. Hospital ethnography and a focus group were implemented. Social workers related vulnerability to the social needs of each patient; however, they state that they have dilemmas to identify a person in a vulnerable condition; these dilemmas are related to social differences and deservingness. Academics indicated that the vulnerability should refer to the lack of access to health services offered by the institution. Academics agree with social workers regarding the importance of considering the overlapped social and individual circumstances in each patient to recognize their vulnerable condition, regardless of belonging to any of the pre-established vulnerable groups. Finally, taking into account the way of conceptualizing vulnerability and how public policy on the identification of vulnerable patients in the hospital has been implemented, these two elements are explained using the palimpsest model, which is a figure of thought that can be applied to analyze the sociocultural significance of this complex issue, as well as other social dynamics.

脆弱性是一个与社会不平等对获得医疗保健服务的影响相关的概念。在医院层面，必须识别弱势群体并优先于其他群体。本研究的目的是分析社会工作者对弱势患者的概念和实践，并确定学术界给出的弱势理论要素。实施了医院民族志和焦点小组。社会工作者将脆弱性与每位患者的社会需求联系起来；然而，他们表示，他们很难确定处于弱势状态的人；这些困境与社会差异和应得性有关。学术界表示，脆弱性应该是指无法获得机构提供的医疗服务。学术界同意社会工作者的观点，认为考虑每位患者重叠的社会和个人情况以识别他们的弱势状况的重要性，无论他们属于任何预先确定的弱势群体。最后，考虑到脆弱性的概念化方式以及关于医院中脆弱患者识别的公共政策是如何实施的，这两个要素使用重写法模型进行解释，该模型是一种可用于分析脆弱性的思维方式。这个复杂问题的社会文化意义，以及其他社会动态。