Holes in the health care safety net: an ethnographic study of a free medical clinic

Abstract

<p>The purpose of this dissertation is to provide insight into the patient and volunteer perspective of their experiences at free medical clinics and, from the analysis of those data, inform health professions education. Many uninsured and underserved patients use the free clinic as their medical home to manage acute and chronic conditions and as a source of prescription medications. The volunteers find their experiences to be a fulfillment of their desire to give back to their community, a way to meet an obligation of professional duty, and hold to the moral belief that they should help those in need. Feminist methodologies and methods consistent with qualitative inquiry were used for data collection and analysis. I propose a pedagogical model to inform cultural competency training in health professions education based on feminist intersectionality theory as the grounding. Patients seeking health care services need to be viewed by health care practitioners and volunteers beyond simplistic demographics and medical conditions. The patient's everyday life cannot be explicated without orienting the health care encounter toward the complexity of the individual's multiple subjectivities and intersecting locations of oppression and subordination. Patient-centered care should strive to create space and time for explicating a rich cultural understanding of the patient. Culturally sensitive health care interventions are derived from this dialogic process. Equally important to the application of this model is the integration of this pedagogy in professional development programs for academic and clinical faculty who serve as role models and preceptors for health professions students</p>