Health care, as well as the aging process in general, is grossly dependent upon cultural diversity. Various cultures all experience aging in their own way - most of which is dependent upon a particular group’s cumulative advantage or disadvantage. This, in turn, leads to a variety of health disparities between groups. Most of the literature on the subject of aging compares groups of people based on race or on religious affiliation. Even though this is an important point of analysis, it is also important to analyze cultural differences within races. A large majority of the United States, for instance, is Caucasian and, within this single race, there is still a great deal of cultural diversity. Unfortunately, many people, including physicians, do not realize the importance of rural culture. Life is different in rural America and, because of this, people behave and process things differently than other areas of the country would. While this is not unique to rural areas of the United States, it does create a noticeable difference when paired with the severe shortage of physicians who practice rural medicine.
This particular article, which was published in the Wall Street Journal earlier this month, provided an interesting analysis of how understanding Iowan culture is essential to the practice of medicine in the area. The primary focus was on Mercy Medical Center in Mason City, which requires “foreign” medical residents to attend two cultural workshops in order to better learn about Iowan culture as well as dialect. After all, if you are not from the area, it is hard to understand how important football and college rivalries are or even how much rural life revolves around the farm and the harvest cycle. The majority of people in rural areas either farm or have a family member who does. And, as the article explained, many patients will refuse to accept bed rest or to even have surgery until after the harvest season is over. Others will ignore an injury or recuperation time in order to push themselves further in sports.
Another problem arises from the language barrier. Even though the physician and the patient may both be fluent in English, a different dialect exists in various parts of the country. Not knowing and, even worse, not understanding an area’s particular dialect can lead to confusion and miscommunication. The article noted that 63 percent of the counties in Iowa have a shortage of physicians which, when combined with cultural ignorance, adds to a poor degree of health care in many rural areas. But, most importantly, one cannot make ill-construed presumptions ofa person just based on their culture. As the article stated:
“An Iowa farmer can be university educated, worth millions of dollars and know all about grain futures. But a rural, small-town feel permeates the culture. It's a place where patients are used to knowing their doctors well, down to the pew their families occupy in church on Sundays…”
This is an important note because many people do tend to associate rural, small-towns with under-educated “hicks.” This presumption and potential lack of small-town understanding can lead to a poor doctor-patient relationship. As the above quote explained, this relationship is dependent upon both parties. Not only must the doctor work hard to understand the patient’s culture, but the patient must also be willing to accept “outside” doctors and their respective cultures. Just as in every relationship, it takes both parties to make it work. And, as always, it is important to learn about others’ backgrounds and cultures and to not prejudge those who we do not yet know.
