A scholarship essay...

I'm in the middle of finals for the summer semester currently. Having little time but a strong desire to post something, here's an essay that I wrote this spring for a scholarship opportunity. Enjoy.

Each time I sit down to write these short words on cultural competency, I am struck by how difficult it is to put my thoughts to the page in such a way that they do not appear contrived and insincere. As a blond haired, blue eyed, pale skinned, middle class, female medical student, I fear I do not have the features that the public associates with a champion for issues surrounding race, class, or ethnicity. However, many life circumstances have compelled me to take a special interest in interracial and interclass dynamics.

As a white student in the Texas public school system, I was by-the-numbers a minority student in both my middle and high schools. Because of this, I quickly learned the existence of cultural and class differences, the labor required to bridge them, and the blessing of doing so. Following high school, I moved to New England to attend a liberal arts college, which desperately attempted to convey the reality of systematic injustices that contribute to the make-up of its mostly white, upper class student body. It was Wheaton’s curriculum, as well as a semester abroad, that helped to contextualize my past experiences and led me to move into inner city Springfield, MA, after college to work with a non-profit organization that has racial reconciliation as one of its main objectives. Ultimately, the social experience of my educational upbringing persuaded me to choose an osteopathic medical school due to the profession’s emphasis on accounting for the physical, mental, and social conditions when planning patient care. Since the practices of both cultural competency and humanistic medicine rely on the fundamental tenet of interconnectedness, it is my opinion that osteopathic physicians should be leading way in the pursuit of excellence in both areas.

Cultural competency can be simply understood as knowing oneself, knowing another, and acting accordingly. For a physician, this entails knowing her own cultural norms surrounding health as well as those of the patient and thereby appropriately providing care. Cultural competence in the medical setting is usually concerned with race or ethnicity; however, I believe there is also a need for competence when working with patients from different economic classes and diverse educational levels. In today’s fast-paced healthcare system, cultural conflict arises when physicians overlook the impact of fundamental beliefs, behaviors, biases, and stereotypes in the patient-doctor interaction and when we as physicians see our professional expectations reduced to proper diagnosis and treatment. In order to be a culturally able physician in a diverse world, one must nurture the capacity for empathy as well as expand her knowledge of the implications of race, class, and other social determinants of health.

In the last year, I have taken two tangible steps toward strengthening my skills as a culturally competent osteopathic physician. First of all, I became a pre-doctoral fellow in the OMM department, which facilitates the honing of my manual medicine skills and has allowed me the opportunity to earn a dual degree (DO/MPH) in public health. Studying medical sociology and medical anthropology has taught me that an individual’s health is largely an expression of the health of the population to which she belongs. The vital signs of population health include socioeconomic standing, public works infrastructure, environmental conditions, political stability, and access to healthcare; it is within the framework of these and many other social and historical circumstances that a health culture is born. Being a physician that formally understands issues surrounding these determinants of health will enable me to more readily and sympathetically understand the context of a patient’s health as well as recognize the health implications of political and social change. Thus, through my public health training, I am learning that it is incumbent on me as a physician to work with and advocate for better public health services in order to both diminish the underlying social and cultural causes of poor health outcomes and maximize the delivery of quality, culturally appropriate clinical care.
In addition to initiating my masters in public health education, I have launched a growing book club composed of 1st, 2nd, and 3rd year medical students. Through the generous funding and unending emotional support of TCOM’s medical ethics department, we read and discuss medical narratives that creatively exhibit the human experience of being a physician. With consideration for the nuance of each clinical case as well as the physician-writer’s existential experience, these texts demonstrate the struggle for physicians to exhibit competence in complex situations. Many of our books, including “The Spirit Catches You and You Fall Down” by Anne Fadiman and “Suffering and Healing in America: an American doctor’s view from outside,” by Raymond Downing, brilliantly present case studies in the importance of practicing culturally competent medicine in today’s diverse social context. It is my goal that by reading these stories of those who have gone before of us into the exciting field of medicine, we will meld our individual experiences as budding physicians with the seasoned experience of others and thus discover a deep capacity to respond with caring knowledge to the medical needs of our diverse patients.

In conclusion, I firmly believe that one of the most overpowering forces that physicians must contend with is the culture we inherit through our training. In order to survive years of bearing the decisions in life and death experiences, doctors in training learn to think of patients in terms of pathology while anaesthetizing themselves from the emotional component of disease. However, regardless of the simplicity of the disease, to the suffering patient of any culture a simple bout of the rhinovirus is more than annoying symptoms. It is an infringement on her capacity to fully participate in life; it is an encounter with mortality, from which she seeks relief when she visits our offices. We must remember this. We must remember that our humanity and ultimately our mortality connect us despite the starkest of differences.