Culture Health and Access
It is most interesting that medical education can focus on "cultural competency" and yet admit medical students that have little hope of identifying with lower and middle income people, much less those with multiple dimensions of differences involving income, language, and a wide range of characteristics important in health care.
How can those who have suffered least, understand human suffering?
How can those who have rarely faced obstacles with uncertainty of outcome, help patients and families facing the greatest uncertainties humans can face?
The privileged clearly have top probability of admission, but the price of privilege is programming that can compromise health care delivery.
Those who face and overcome obstacles of income, education, parents, and more are more prepared for challenging health access careers, and not surprisingly choose most needed health access at the highest levels.
Geert Hofstede - Consequences of Culture People are not software, but people and software can be programmed. Attitudes, behaviors, and actions are programmed. Humans can change their programming, but at great cost of effort. Service orientation, people skills, and many of the important skills for physicians are often programmed away away from birth to admission for many medical students. Preservation of empathy and communication skills can be difficult over the course of life and medical school. Power distance, individualism versus collectivism, masculinity versus femininity, and short versus long term orientation are all key factors in basic health access as well as in health care cost and health care quality.
Hofstede's work has been criticised for its artificial divisions by individual nations. Within nations there are infinite variations. Programming is an important consideration. Just a few areas of programming include physician superiority, marginalization of medical students and other learners, the priority of physicians to defer their own needs as compared to patient needs, the culture of medicine that conflicts with the culture of patients (The Spirit Catches You - Fadiman), a design of health care that results in care for all patients instead of a privileged few, short term cures common in subspecialty focus as compared to the long term focus required in preventive care, public health, basic health access, and the decades required to assure each of these priorities.
Business fails within nations and between nations when there is failure to consider "programming." There is a most basic requirement of awareness and understanding. Typically immersion in one another's culture and language is a minimal step.
While being patient-centered or culturally competent are common vocabulary for medical care and medical education, these are most difficult concepts for those who are selected and trained to become physicians.
The current United States design assures that those that become physicians are born, raised, educated, and trained in a culture of top concentrations. This is a culture different and distant from most Americans. Parent influences insure that those most likely to become physicians must overcome their programming to be able to deliver health care efficiently and effectively, especially the top people skills areas such as basic access to health.
Robert C. Bowman, M.D.
Winner Take All by Robert H. Frank is also a useful site for understanding the reasons for lack of progress Wiki site for Robert H. Frank including the cost of maintaining status, the role of emotions
Real Diversity Extremes in Physician Workforce Diverse admissions are often considered "different" but are actually more normal in origins, career choice, and in distribution where most needed. Extremely different children of the most concentrated origins are extremely exclusive and make exclusive career and location choices. Only a small fraction of the American population is as extreme as the physicians that enter the US workforce. And the nation's physicians are getting even more exclusive/diverse/different in origins.
Education Aspects: Birth to Admission Considerations in America As Cultural Variation
Experiential Place and Health Access Considerations
The Counterproductive and Untrue Perspective of the Impossibility of Health Access
Why Physician Workforce Needs New Tools (and a health access perspective)
Basic Health Access Index
Physician Workforce Studies