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The opening images for this chapter depict the inner depths of the mod- ern health care system’s culture. Figure 8–1 is an example of the doors to an emergency room or a surgical suite. These doors are closed to all except those sanctioned to enter. Few people outside of this closed system understand the intricacies of the cultures of health care and the meanings of the culture’s knowledge and rituals, beliefs, and practices. Figure 8–2 is a well-equipped modern emergency room. Figure 8–3 is an operating room, and Figure 8–4 is a neo-natal intensive care unit. Each of the last 3 images illustrates the amount of high-technological equipment that is found in today’s hospital. The knowledge and training necessary to use these items are extensive and costly. The equip- ment is extremely expensive, and many institutions have many units equipped such as these. The personnel responsible for delivering care in these technical settings are highly skilled. These 3 images suggest one of the reasons for the ex- traordinary costs of health care to be discussed in this chapter. In fact, as will be discussed in this chapter, it has been frequently demonstrated that the high cost of health care is not proof of high quality (Abelson, 2007, p. A-1) What are the unique symbols of your profession within the overall culture of modern health care? What settings or objects would you choose to represent your experiences of modern health care delivery?
The health care system of this nation has been in crisis, and the visionary words and observations of Dr. John Knowles in 1970 ring true today:
American medicine, the pride of the nation for many years, stands on the brink of chaos. Our medical practitioners have their great moments of drama and triumph. But, much of U.S. medical care, particularly the every- day business of preventing and treating illness, is inferior in quality, waste- fully dispensed, and inequitably financed.
What is it about our health care system and the people who practice within it that generated and continue to generate these comments? This chapter presents an overview of the issues inherent in the acculturation of health care providers and the health care delivery system in the United States. It begins by discuss- ing the norms of the health care provider “cultures” and then examines many of the salient issues regarding the health care system in general.
■ The Health Care Provider’s Culture The providers of health care—nurses; physicians; social workers; dietitians; physical, occupational, respiratory, and speech therapists; and laboratory and departmental professionals—are socialized into the culture of their profes- sion. Professional socialization teaches the student a set of beliefs, practices, habits, likes, dislikes, norms, and rituals. Each of the professional disciplines has its own language and objects, rituals, garments, and myths, which become an inherent part of the scope of students’ education, socialization, and prac- tice. The providers view time in their own ways, and they believe that their view of a health and illness situation and subsequent interventions are the only
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possible answers to the complex questions surrounding a health-related event. This newly learned information regarding health and illness differs in varying degrees from that of the individual’s heritage. As students become more and more immersed and knowledgeable in the scientific and technological domains, they usually move further and further from their past belief systems and, in- deed, further from the population at large in terms of its understanding and beliefs regarding health/HEALTH and illness/ILLNESS. Just as it is not unusual to hear providers say, “Etoh, bid, tid, im, iv,” and so forth, it is not uncom- mon to hear patients say things such as “I have no idea what the nurses and doctors are saying!” “They speak a foreign language!” “What they are doing is so strange to me.” In addition, there exists an underlying cultural norm among health care providers that “all must be done to save a patient, regardless of the patient’s and family’s wishes” and regardless of the financial consequences to the patient and family, to the health care system, or to society in general. A consequence of this philosophy has been the rise of iatrogenic health problems and the escalation of out-of-control health care costs.
As a result, health care providers can be viewed as an alien or foreign cul- ture or ethnic group. They have a social and cultural system; they experience “ethnicity” in the way they perceive themselves in relation to the health care consumer and often each other. Even if they deny the reality of the situation, health care providers must understand that they are ethnocentric. Not only are they ethnocentric, but also many of them are xenophobic. To appreciate this critical issue, consider the following. A principal reason for the difficulty ex- perienced between the health care provider and the consumer is that health care providers, in general, adhere rigidly to the modern allopathic, or Western, system of health care delivery. (These terms may be used interchangeably to describe health care.) With few exceptions, they do not publicly sanction any methods of protection or healing other than scientifically proved ones. They or- dinarily fail to recognize or use any sources of medication other than those that have been deemed effective by scientific means. The only types of healers that are sanctioned are those that have been educated, licensed, and certified according to the requirements of this culture.
What happens, then, when people of one belief system encounter people who have other beliefs regarding health and illness (either in protection or in treatment)? Is the provider able to meet the needs as perceived and defined by the patient? More often than not, a wall of misunderstanding arises be- tween the two. At this point, a breakdown in communications occurs, and the consumer ends up at a disadvantage.
Providers think that they comprehend all facets of health and illness and may frequently take a xenophobic view to HEALTH and ILLNESS and traditional HEALERS. Although in training and education health care providers have a significant advantage over the consumer-patient, it is entirely appropriate for them to explore other ideas regarding health/HEALTH and illness/ILLNESS and to adjust their approach to coincide with the needs of the specific patient. Health care providers have tried to force Western medicine on one and all, regardless of results.