Physicians and patients of the United States are members of the American culture. Together with their fellow citizens they live in a common physical environment and are immersed in a social milieu of conventional beliefs, customs, behavioral patterns, and activities. It is difficult to escape the deluge of visual and verbal symbols of native culture unabashedly poured forth by word and picture machines, the controllers of which strive ceaselessly to satisfy a voracious public appetite of bulimic proportions. Rapid, economical transportation systems foster easy access to far-away regions and locales; in the United States, people love to travel and like vacations, and their commercial enterprises often impel distant relocations of their homes. Having no propensities for being hermits and rather given to making and hearing talk, they are, so to speak, over their heads in the lively Americanscene.
Immersion in the social milieu begins in infancy, and one must struggle
Bunge RG. NEW FACES FOR A NEW ERA IN MEDICINE. JAMA. 1960;173(13):1438-1441. doi:10.1001/jama.1960.03020310026009