The class activity started well. The students were genuinely engaged. We had just finished our annual cultural simulation in our school’s “Care of Diverse Populations” course. Students were divided into two groups, each of which was assigned a distinct culture to adopt. The groups then took turns visiting the other culture and trying to successfully interact. Often, students struggle during these visits and have many misconceptions about the other culture—highlighting this is the intent. This struggle leads to revelatory moments about perception, bias and communication. Afterwards, we debriefed and asked students to describe the other culture. As usual, they listed negative qualities, such as rude, prejudiced and unwelcoming. Then, surprisingly, one student shouted “Republican,” at which the class laughed and nodded. Even more surprisingly, no one spoke up in disagreement. I was disheartened. The students had missed the entire point.
Something similar occurred during a recent debate exercise. Students were split into groups to debate a current healthcare issue. One of the debate topics was Hillary Clinton’s health care reform versus Donald Trump’s. Topics were placed in an envelope and group leaders were asked to reach in and pick one. Students were adamant about not wanting to pick Donald Trump’s side. Their hands were literally shaking as they reached into the envelope: no one wanted to face their group’s wrath if they chose Trump. When Trump was eventually picked by an unlucky leader, his entire group moaned in frustration, while the other students uttered literal sighs of relief. Once again, no one seemed concerned about what had transpired. This response was considered the social norm.
Occurrences such as these, involving both students and faculty, are increasingly common. In health professions curricula, students are taught to be culturally competent. Yet, despite challenging students to provide optimal care for those who differ from them, we are often dismissive and condescending towards people with different political beliefs. As a faculty member, I would be remiss if I allowed any student to provide poor care to anyone ever. After all, these students are the future practitioners, policy-makers and faculty of my profession. After many discussions with colleagues who’ve had similar experiences, I’ve become concerned about the future of health care—and especially the academic environments in which students are trained. What are the ramifications of a lack of viewpoint diversity within the student, faculty and administrative body? What kinds of health professionals are entering the workforce? How could this impact patients?
What Is Viewpoint Diversity?
Heterodox Academy defines viewpoint diversity as “the state of a community or group in which members approach questions or problems from multiple perspectives” and it “enables colleges and universities to realize their twin goals of producing the best research and providing the best education.” Currently, lack of viewpoint diversity (e.g. political diversity) is an epidemic within academia, especially in the humanities and social sciences. Political affiliation impacts many important preferences, including where people choose to live, who they choose to marry, who they prefer their relatives to marry, and who they choose as friends. Essentially, people surround themselves with the like-minded in echo chambers. This increases distrust and animosity towards those who differ politically. The healthcare professions are not protected from this cultural shift. Can students, faculty and institutions which take strong political stances provide optimal care for patients and communities that differ from them politically— when research indicates growing divisiveness and animosity?
The Value of Different Viewpoints
A lack of viewpoint diversity may impact patients in several ways. First and foremost, a practitioner’s political stance may influence their treatment decisions. One study found that Democrat and Republican physicians differ in how they would treat patients facing politicized health issues. I’ve witnessed politically conservative pharmacists refuse to provide Plan B and campaign against safe injection programs and medical marijuana. Furthermore, healthcare shortages in specific areas could be caused by providers choosing not to live or work in those places because of their political affiliations. Voting patterns overwhelmingly indicate that people with similar political beliefs choose to live near each other. This shift towards political homogeneity within communities may explain the lack of health professionals in certain settings. Lastly, research shows that some patients prefer practitioners of the same race and/or native language. Is this effect also seen with political concordance? Are some patients not receiving optimal care because they differ politically from their provider? Are some patients and communities not receiving the best care because certain political beliefs are not represented among providers and policies in that community?
Every political ideology has flaws, inconsistencies and failures. The moment we stop critiquing each other is the moment we open ourselves up to these blind spots. Having diverse political beliefs will not only keep our own bias in check, but lead to rigorous debate, higher quality work and better policies.
I do not wish to promote particular political views or demean other aspects of diversity here, but to bring to light issues associated with homogeneous thought, especially in academic institutions, which train impressionable minds. If a student is only taught one perspective on a politically divisive health care issue (e.g. birth control, marijuana, substance abuse/opioids, universal health care, religious grounds for refusal, entitlement programs, capitalism, Big Pharma), is that student really gaining a full appreciation of what their patients believe and value? We also want students to be aware of current and evolving issues within health care. If students hear only one side of an argument and surround themselves with others who think like them (which evidence shows they do), they will lack the ability to grasp the complexity of an issue and the arguments involved. What kinds of policies and initiatives are likely to result from these incomplete understandings?
The Current Environment
How are students and practitioners impacted by this societal shift towards political intolerance and decreased willingness to engage with different viewpoints? We don’t know. There has been a lack of research into viewpoint diversity and its relationship to quality of care. Now is the time to assess this topic. There’s no reason to believe that polarization will lessen or remain stagnant as people become more segregated by their political beliefs. In fact, undergraduate students are becoming increasingly polarized and differences in people’s values and beliefs—as demonstrated by implicit, explicit and behavioral indicators—are largely determined by politics, even more than by race. Furthermore, note the demographic profile of faculty and administration in the health professions—white, educated, older, urban. This is statistically the most politically intolerant group.
In other academic professions, the roots of political homogeneity run deep and, although new dialogue is emerging (often due to controversy), there is much more work to be done regarding viewpoint diversity. The recently released American Psychological Association’s Guidelines for Psychological Practice with Boys and Men attracted a vast amount of criticism—the controversy underscores our stark differences along political and ideological lines. This divisiveness might enter the health professions as well. It is unclear how it might manifest itself.
With few exceptions, higher education has repeatedly shown that it is not interested in promoting political diversity. Although the government is beginning to exert its influence, ensuring viewpoint diversity in the health professions is the responsibility of the health professions themselves. There is no reason why we should let this issue become as intractable as it has become in some other fields. Change will not occur accidentally, but requires purposeful intent, thought and planning. New tools promoting viewpoint diversity are available for use by individuals and institutions. Additionally, utilizing existing personnel dedicated to diversity and inclusion is critical. At a personal, institution and profession-wide level, we should ask the following questions:
- Value: Do we want viewpoint diversity? Why or why not?
- Assessment: Do we have viewpoint diversity?
- Action: What will we do to maintain or improve viewpoint diversity?
The health professions are not immune from societal shifts. I fear that increasing political polarization and echo chambers will further entrench animosity, leading to decreased ability and willingness to care for certain people and less consideration given to helpful policies of a different political slant. Ultimately, a homogeneous political climate and decreased political tolerance will hurt students and patients. Our role as healthcare providers is to heal this growing divide, not contribute to it.